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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Topical anesthetics for intravenous insertion in children: a randomized equivalency study.
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Topical anesthetics for intravenous insertion in children: a randomized equivalency study.

机译：儿童静脉内麻醉的局部麻醉剂：一项随机等效研究。

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OBJECTIVES: Children view needle sticks as the worst source of pain and fear in the hospital setting. In an effort to minimize the pain of needle sticks, the use of eutectic mixture of lidocaine and prilocaine (EMLA) has become standard practice in many children's hospitals. Unfortunately, EMLA requires at least 60 minutes to be fully effective and reportedly may cause vasoconstriction, leading to difficult vein cannulation. A newly available local anesthetic (ELA-Max) may require less time and cause less vasoconstriction. The purpose of this randomized crossover study was to investigate the anesthetic equivalence of EMLA and ELA-Max. METHODS: Thirty well children (14 girls and 16 boys) who were between the ages of 7 and 13 years volunteered to have EMLA applied to the dorsal aspect of 1 hand for 60 minutes and ELA-Max applied to the other hand for 30 minutes. Right and left hands were randomized to treatment type and order of intravenous (IV) insertion. Clinical Research Center nurses, blind to the anesthetic randomization, attempted to insert a 22-gauge Teflon IV catheter into a vein in each hand. The children rated pain during IV insertion on the Oucher scale, and the nurse rated the difficulty of the insertion. RESULTS: There was no significant difference in pain ratings for hands that were treated with EMLA (mean: 20.5) or with ELA-Max (mean: 24), and there was no difference for the difficulty of vein cannulation. Children's preprocedure state anxiety was positively associated with pain ratings. CONCLUSIONS: ELA-Max, applied for 30 minutes before IV cannulation, has an anesthetic effectiveness similar to EMLA applied for 60 minutes. Some children rated IV insertion pain fairly high for both hands (eg, 60 on a 0- to 100-point scale) despite anesthetic treatment. Preprocedural anxiety may affect the perception and/or rating of pain. There were no differences between hands that were treated with EMLA or with ELA-Max for success of IV insertion.
机译：目的：在医院里，儿童认为针刺是疼痛和恐惧的最严重来源。为了尽量减少针刺的疼痛，利多卡因和丙胺卡因的共晶混合物（EMLA）的使用已成为许多儿童医院的标准做法。不幸的是，EMLA至少需要60分钟才能完全有效，并且据报道可能引起血管收缩，导致难以进行静脉插管。新近可用的局麻药（ELA-Max）可能需要更短的时间并引起更少的血管收缩。这项随机交叉研究的目的是研究EMLA和ELA-Max的麻醉等效性。方法：年龄在7至13岁之间的30名健康儿童（14名女孩和16名男孩）自愿将EMLA应用于一只手的背面60分钟，而将ELA-Max应用于另一只手30分钟。右手和左手被随机分配到治疗类型和静脉内（IV）插入顺序。临床研究中心的护士对麻醉的随机性视而不见，他们试图每只手将22号Teflon IV导管插入静脉。在Oucher量表上，儿童对静脉插管时的疼痛进行了评分，护士对插管的难度进行了评分。结果：用EMLA（平均：20.5）或ELA-Max（平均：24）治疗的手的疼痛等级没有显着差异，并且静脉插管的难度也没有差异。儿童的术前状态焦虑与疼痛等级呈正相关。结论：IVA插管前30分钟使用ELA-Max，其麻醉效果类似于EMLA 60分钟。一些孩子尽管接受了麻醉治疗，但两只手的静脉插管疼痛相当严重（例如，0至100点为60）。术前焦虑可能会影响疼痛的感知和/或等级。用EMLA或用ELA-Max处理的手之间成功插入IV的手之间没有差异。

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