Lidocaine iontophoresis for topical anesthesia before intravenous line placement in children,☆☆,,★★

Presented at the Annual Meeting of the American Academy of Pediatrics, Section of Emergency Medicine, Boston, Massachusetts, October 26-30, 1996.
https://doi.org/10.1016/S0022-3476(98)70413-5Get rights and content

Abstract

In a double-blind randomized trial including 42 children aged 7 to 18 years, less pain occurred with intravenous placement after iontophoresis of 2% lidocaine with epinephrine, as reported by patients (p = 0.005), parents (p = 0.001), intravenous personnel (p = 0.009), and investigators (p = 0.0002) compared with placebo therapy. Lidocaine iontophoresis provides rapid and effective topical anesthesia for intravenous access in children. (J Pediatr 1998;132:1061-3.)

Section snippets

Study Design

Patients in an emergency department who were between 7 and 18 years old and required intravenous access were randomized to lidocaine (2%, with 1:100,000 epinephrine, N = 22) or placebo (normal saline solution, with 1:100,000 epinephrine, N = 20). Patients who required emergent placement of intravenous catheters or who had unstable vital signs, clinical evidence of dehydration, lidocaine allergy, decreased mental status, or a pacemaker were excluded. Children with mental retardation and those

RESULTS

There were no significant differences in the demographic variables between the lidocaine and placebo groups. Iontophoresis (30 mAmin) required 10.8 ± 3.6 minutes in the lidocaine and 10.7 ± 3.5 minutes in the placebo group (p = NS).

Less pain occurred during intravenous placement in the lidocaine group than in the placebo group, measured by 100 mm visual analog scales (p = 0.005, Table) and by the ordinal pain scale (p = 0.002).

Table. Visual analog scale scores for pain at time of intravenous

DISCUSSION

From a double-blind randomized trial we report that the topical anesthesia after lidocaine iontophoresis effectively reduces the pain from intravenous catheter placement in children, thus confirming the results of a similar study in 44 adult patients.5 The success rate for intravenous access in our study was approximately 80% and was similar to the success rates reported for intravenous access in patients in a pediatric emergency department.8

Tingling, warmth, itching, and erythema beneath the

References (12)

There are more references available in the full text version of this article.

Cited by (78)

  • Effective use of transdermal drug delivery in children

    2014, Advanced Drug Delivery Reviews
    Citation Excerpt :

    The earliest paediatric application was the iontophoretic delivery of lidocaine to provide local anaesthesia prior to venous sampling and minor dermatological interventions. Implementation first involved the use of a power supply (Iomed® Phoresor II Auto) and disposable electrodes, which could be either filled prior to use by the practitioner [159] or prefilled (NumbyStuff®) [160] with a solution containing 2% lidocaine and 1:100,000 epinephrine. The second active aimed to induce local vasoconstriction and reduce lidocaine clearance into the systemic circulation.

  • Next generation intra- and transdermal therapeutic systems: Using non- and minimally-invasive technologies to increase drug delivery into and across the skin

    2013, European Journal of Pharmaceutical Sciences
    Citation Excerpt :

    Iontophoresis is not a new technology and the proof-of-principle was demonstrated early in the last century. Since then several portable power supplies have been developed that are used in combination with fill-on-site patches, which typically consist of an absorbent material that imbibes an aqueous drug solution (e.g., dexamethasone sodium phosphate or lidocaine (Zempsky et al., 1998)); such systems have been frequently used in physical therapy. The challenge has been to develop pre-filled iontophoretic patch systems akin to conventional transdermal patches that are now in routine use.

  • Warm Lidocaine/Tetracaine Patch Versus Placebo Before Pediatric Intravenous Cannulation: A Randomized Controlled Trial

    2008, Annals of Emergency Medicine
    Citation Excerpt :

    However, these methods may be slightly uncomfortable, often result in local erythema, and require special instruments. Use of electricity (iontophoresis) or ultrasonic waves (sonophoresis) also enhances transdermal delivery of anesthetics yet also requires special instruments8,9 and in our own experience can be threatening and unpleasant in children. Other nonpharmacologic methods of reducing the pain of IV cannulation, such as ice or ethylene chloride, have not been shown to be effective.25,26

View all citing articles on Scopus

From the Departments of Pediatrics, Epidemiology, and Pharmacy, Egleston Children's Hospital, Emory University School of Medicine, Atlanta, Georgia.

☆☆

Partially funded by a grant from Iomed Inc., Salt Lake City, Utah.

Reprint requests: William T. Zempsky, MD, Division of Pediatric Emergency Medicine, Connecticut Children's Medical Center, 282 Washington St., Hartford, CT 06106.

★★

0022-3476/98/$5.00 + 0 9/22/87380

View full text