Comparison of the Effectiveness of EMLA Cream, 2% Lidocaine Gel, and Ice Bag on Pain Intensity Caused by Venipuncture in Children Aged 6-12 Years

Intravenous catheter placement is one of the most common invasive care measures performed by nurses. Considering the contradictory results obtained regarding the effect of local analgesic techniques, the present study was conducted to compare the effect of EMLA cream vs. 2% lidocaine gel vs. ice bag on pain intensity caused by venipuncture in children aged 6-12 years.

In this clinical trial, 160 children undergoing elective surgery were selected according to the inclusion and exclusion criteria and were divided into 4 groups of 40 using block randomization method. In this study, pain intensity was measured based on patient self-report and by nurses during venipuncture while applying EMLA cream, 2% lidocaine gel, and ice bag using the numeric analog scale (NAS) and the FLACC scale which included 5 criteria for child behavior. The range of scores in both scales is recorded from 0 to 10, where 0 indicates absence of pain. The data were collected using dispersion indices. Kruskal-Wallis test and chi-square test were used to compare the numerical scale of pain and behavior between groups using SPSS-16 statistical software.

The mean age of the participants was 7.79±1.79 years, and 80 (50%) were male. The results showed that the mean values of pain intensity based on the numerical scale in the control, EMLA cream, lidocaine gel, and ice bag group were 4±0.78, 0.9±0.75, 2.80±0.18, and 2.60±0.67, respectively. Moreover, there was a statistically significant difference between the groups according to numerical scale and behavioral scale (P<0.001), with the EMLA cream group expressing a lower level of pain based on both scales.

The results of the present study showed that the use of all three methods of EMLA cream, lidocaine gel, and ice bag reduced pain during venipuncture. The EMLA cream was associated with a higher amount of pain reduction compared to the other two methods. Therefore, EMLA cream could be recommended to be used routinely in the target area one hour before catheter placement.