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European Journal of Pediatrics

, Volume 169, Issue 12, pp 1465–1469 | Cite as

Pain reduction in children during port-à-cath catheter puncture using local anaesthesia with EMLA™

  • Birke Lüllmann
  • Johannes Leonhardt
  • Martin Metzelder
  • Ludwig Hoy
  • Heidrun Gerr
  • Christin Linderkamp
  • Christoph Klein
  • Lorenz GrigullEmail author
Original Paper

Abstract

Introduction

Alleviating pain is of high importance for children undergoing chemotherapy. Eutectic mixture of lidocain-prilocain cream (EMLA) is assumed to require 60 min application time.

Materials and methods

We prospectively compared the pain during port-à-cath punctures after 40 min compared to 60 min of application time. A prospective, unblinded, cross-over study was performed. The children received two punctures during their chemotherapy protocol. Patients in group 1 had the first puncture after 40 min EMLA application time. Their second puncture (approximately a week later) was done after 60 min. Patients in group 2 started after 40 min. Pain was scored using the visual analogue scale (VAS) and the Bieri scale. Patients, parents and a nurse scaled the pain after the intervention. Eighty-seven children between 2 and 18 years with different malignant diseases were included.

Results and discussion

On the VAS pain scale, the mean pain was 2.3 (minimum 0, maximum 9.2) after 40 min and 1.9 (minimum 0, maximum 9.4) after 60 min according to the observations of the nurse and very similarly according to the parents’ observations. The children expressed more pain after 40 min of EMLA application time (mean pain, 3.5) and a significant pain reduction after 60 min application time (mean pain 1.7).

Conclusion

In this study children experienced less pain after 60 min application time, but pain reduction was already seen after 40 min. The child’s perception of pain differed from observers’ point of view and should therefore always be included in pain management.

Keywords

Pain Port catheter EMLA Cancer Childhood 

Notes

Acknowledgements

The authors thank the patients and their families who participated in this trial, the physicians and nurses of the paediatric oncology ward for their input in performing this study. The authors also thank Annette Frank-Hoppe, Ute Nikolaizik and Christiane Schirmer for excellent study monitoring. Clemens Betzel is acknowledged for revising the manuscript.

Conflict of interest

None.

References

  1. 1.
    Bishai R, Taddio A, Bar-Oz B et al (1999) Relative efficacy of amethocaine gel and lidocaine-prilocaine cream for port-a-cath puncture in children. Pediatrics 104(3):e31CrossRefPubMedGoogle Scholar
  2. 2.
    Chambers CT, Giesbrecht K, Craig KD et al (1999) A comparison of faces scales for the measurement of pediatric pain: childrens and parents ratings. Pain 83:25–35CrossRefPubMedGoogle Scholar
  3. 3.
    Chen BK, Cunningham MD (2001) Topical anaesthetics in children: agents and techniques that equally comfort patients, parents and clinicans. Curr Opin Pediatr 13:324–330CrossRefPubMedGoogle Scholar
  4. 4.
    Choy L, Warrson AR (1999) Comparison of lidocaine-prilocaine cream and amethocaine gel for local analgesia before venepuncture in children. Acta Paediatr 88(9):961–964CrossRefPubMedGoogle Scholar
  5. 5.
    Cordoni AMSN, Cordonie LE (2001) Eutetic mixture of local anesthetics reduces pain during intravenous catheter insertion in the pediatric patient. Clin J Pain 17:115–118CrossRefPubMedGoogle Scholar
  6. 6.
    Cummings EA, Reid GJ, Finley GA, McGrath PJ et al (1996) Prevalence and source of pain in pediatric inpatients. Pain 68:25–31CrossRefPubMedGoogle Scholar
  7. 7.
    Hain RD (1997) Pain scales in children: a review. Palliat Med 11:341–350CrossRefPubMedGoogle Scholar
  8. 8.
    Halperin D, Koren G, Pellegrini E et al (1989) Topical skin anesthesia for venous, subcutaneous drug reservoir and lumbar punctures in children. Pediatrics 84:281–284PubMedGoogle Scholar
  9. 9.
    Johansson E, Engervall P, Björvell H et al (2009) Patients’ perceptions of having a central venous catheter or a totally implantable subcutaneous port system-results from a randomised study in acute leukaemia. Support Care Cancer 17(2):137–143CrossRefPubMedGoogle Scholar
  10. 10.
    Kleiber C, Sorenson M, Whiteside K et al (2002) Topical anesthetics for intravenous insertion in children: a randomized equivalency study. Pediatrics 110:758–761CrossRefPubMedGoogle Scholar
  11. 11.
    Miser AW, Suan Goh T, Dose AM et al (1994) Trial of a topically admistered local anesthetic (EMLA cream) for pain relief during central venous port accesses in children with cancer. J Pain Symptom Manage 9:259–264CrossRefPubMedGoogle Scholar
  12. 12.
    Nott MR (1990) Relief of injection pain in adults. EMLA cream for 5 min before venepuncture. Anasthesia 45:772–774CrossRefGoogle Scholar
  13. 13.
    Teillol-Foo WL, Kassab JY (1991) Topical glyceryl trinitrate and eutectic mixture of local anaesthetics in children. A randomized controlled trial on choice of site and ease of venous cannulation. Anaesthesia 46:881–884CrossRefPubMedGoogle Scholar
  14. 14.
    Wongaprarasuk P (1998) Adverse local reactions to amethocaine cream-audit and case report. Anaesth Intensive Care 26(3):312–314Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Birke Lüllmann
    • 1
  • Johannes Leonhardt
    • 2
  • Martin Metzelder
    • 3
  • Ludwig Hoy
    • 4
  • Heidrun Gerr
    • 1
  • Christin Linderkamp
    • 1
  • Christoph Klein
    • 1
  • Lorenz Grigull
    • 1
    • 5
    Email author
  1. 1.Department of Paediatric Haematology and OncologyMedical UniversityHannoverGermany
  2. 2.Department of Paediatric SurgerySt. Bernward HospitalHildesheimGermany
  3. 3.Department of Paediatric SurgeryMedical UniversityHannoverGermany
  4. 4.Department of Medical StatisticsMedical UniversityHannoverGermany
  5. 5.Department of Paediatric Haematology and OncologyOE 6780 Medizinische Hochschule HannoverHannoverGermany

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