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Comparison of the use of the Valsalva maneuver and the eutectic mixture of local anesthetics (EMLA®) to relieve venipuncture pain: a randomized controlled trial

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Abstract

Purpose

Intravenous cannulation is a painful and stressful procedure. The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics (EMLA®) with that of the Valsalva maneuver in adult patients during i.v. cannulation.

Methods

One hundred ninety-five patients were randomized prospectively to three groups. The dorsum of the nondominant hand was covered with a thick paste of 2.5 g of EMLA® cream in the EMLA® group (group E) and left for a minimum of 30 min before venipuncture. In the control group (group C), the same procedure was applied except that Vaseline® was used instead of the EMLA®. The Valsalva group (group V) were punctured during a Valsalva maneuver. The patients were placed in the supine position during venipuncture. The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale (NRS; 0 = no pain, 10 = extreme pain).

Results

Thirteen patients were excluded from the analysis due to failed cannulation. There was no difference in the demographic profiles of the groups (p > 0.05). The success of VP was significantly higher in group V than in groups E and C (p < 0.001). The median pain score as assessed by the NRS after venipuncture in group C was 3 (range 0–9), whereas the median pain values in groups E and V were 2 (range 0–7) and 2 (range 1–8).

Conclusions

The Valsalva maneuver yields similar results to the EMLA® in terms of pain reduction during venipuncture.

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Acknowledgments

We wish to express our gratitude to Mr. Haluk Özdemir, Ismail Okan, and Bora Bostan for their critical reading of the manuscript. There was no financial support or sponsorship of this work, and the authors state that there is no conflict of interest.

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Authors and Affiliations

  1. Department of Anesthesiology and Reanimation, Medical Faculty, Gaziosmanpasa University, 60300, Tokat, Turkey

    Mustafa Suren, Ziya Kaya, Semih Arıcı & Serkan Karaman

  2. Department of Anesthesiology and Reanimation, Medical Faculty, 19 Mayıs University, Samsun, Turkey

    Fatih Ozkan

  3. Department of Biostatistics, Medical Faculty, Gaziosmanpasa University, Tokat, Turkey

    Unal Erkorkmaz

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  1. Mustafa Suren
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  2. Ziya Kaya
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  3. Fatih Ozkan
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  4. Unal Erkorkmaz
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  5. Semih Arıcı
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Correspondence to Mustafa Suren.

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Suren, M., Kaya, Z., Ozkan, F. et al. Comparison of the use of the Valsalva maneuver and the eutectic mixture of local anesthetics (EMLA®) to relieve venipuncture pain: a randomized controlled trial. J Anesth 27, 407–411 (2013). https://doi.org/10.1007/s00540-012-1540-1

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  • DOI: https://doi.org/10.1007/s00540-012-1540-1

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