Efficacy of parental application of eutectic mixture of local anesthetics for intravenous insertion

Objective. To demonstrate that parent application of eutectic mixture of lo cal anesthetics (EMLA) results in equal reduction of the pain of intravenou s (IV) placement compared with clinician application of EMLA, and to assess potential difficulties with parental application. Study Design. A 2 x 2 randomized block design was used, with 41 children di vided into two age groups (5-12 years vs 13-18 years) and randomized to one of two experimental groups (parent-applied EMLA vs clinician-applied EMLA) . Methods. All children were scheduled to have outpatient gastrointestinal en doscopies with IV sedation. EMLA was placed at least 60 minutes before IV i nsertion either by the parent or a clinician, depending on the experimental group assignment. Outcome measures were child pain ratings and observed be havioral distress ratings. Parents and children were interviewed to determi ne parent and child anxiety levels in anticipation of the IV insertion, pre vious needle stick experience, and previous difficulty coping. Feasibility outcomes included technical difficulty with application of EMLA and appeara nce of the EMLA cream and occlusive covering. Results. Pain ratings and behavioral distress ratings were generally in the low to moderate range for all groups and were consistent with previous emp iric reports of EMLA outcome. There were no significant differences in pain or distress ratings for either the age or the experimental groups. Parent ratings of their child's previous difficulty coping was related to the leve l of behavioral distress exhibited before (r = .50), during (r = .32) and a fter (r = .44) the IV insertion. In addition, children's anxiety ratings ab out IV insertion seemed to differ among groups (although not statistically significant for post hoc comparisons), with the most anxiety reported by th e younger children when clinicians applied the EMLA and by older children w hen parents applied the EMLA. Conclusion. Parent application of EMLA appears to be as effective as clinic ian application in reducing children's pain and distress associated with IV insertion. Permitting parents to apply the EMLA at home can allow children who are having procedures on an outpatient basis to benefit from topical a nesthesia without having to arrive early to the clinic or hospital. Additio nally, application by parents may result in less anticipatory anxiety for y ounger children.