Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture

Eutectic mixture of local anaesthetics (EMLA) cream is used routinely as a local anaesthetic prior to venepuncture in children. Despite this, however, a significant proportion of children will still be distressed. Cognitive-b ehavioural interventions, such as distraction by breathing and blowing exer cises, have been used and found to be helpful as alternative coping strateg ies. There is, however, a paucity of data regarding effectiveness. We have evaluated the efficacy of distraction therapy as a coping strategy before a nd during venepuncture, and in these children evaluated the need for EMLA u sing a prospective, randomized, double-blind, placebo-controlled clinical t rial. Twenty-eight children attending for venepuncture were recruited, medi an age 6 y (range 4-8 y), and randomly allocated to receive either EMLA or a placebo cream. All were given distraction therapy prior to and during the procedure by a play specialist. Venepuncture was carried out by one invest igator. A modified paediatric pain assessment chart was used for objective pain score at the end of the procedure. After one exclusion, the treatment group (17 children) and the placebo group (10 children) were similar: media n age of 6 and 7 y (range 4-8), median baseline and postprocedure heart rat e and oxygen saturation. The median (interquartile range) for total pain sc ore in the treatment group was 1 (0 to 4.5) and in the control group 1 (0 t o 2.3). There was no significant difference in pain score between the two g roups (Mann-Whitney test, p = 0.7). The 95% confidence interval for the dif ference in pain score was -1.0 to +3.0. Conclusions: The low pain score in both groups suggests the effectiveness o f distraction therapy, although factors such as skill of the operator and p revious experience of the patient group are of relevance. There was no sign ificant difference in the pain score between the EMLA and placebo groups, s uggesting that in this age group if carefully selected children receive dis traction during venepuncture EMLA may not be necessary.