Lidocaine iontophoresis for topical anesthesia before intravenous line placement in children☆,☆☆,★,★★
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).
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
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Cited by (78)
Effective use of transdermal drug delivery in children
2014, Advanced Drug Delivery ReviewsCitation 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 SciencesCitation 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.
The Effect of Needle Bevel Position on Pain for Subcutaneous Lidocaine Injection
2009, Journal of Perianesthesia NursingWarm Lidocaine/Tetracaine Patch Versus Placebo Before Pediatric Intravenous Cannulation: A Randomized Controlled Trial
2008, Annals of Emergency MedicineCitation 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
Focused ultrasound enhances the anesthetic effects of topical lidocaine in rats
2021, BMC AnesthesiologyTargeted Delivery of Anesthetic Agents to Bone Tissues using Conductive Microneedles Enhanced Iontophoresis for Painless Dental Anesthesia
2021, Advanced Functional Materials
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From the Departments of Pediatrics, Epidemiology, and Pharmacy, Egleston Children's Hospital, Emory University School of Medicine, Atlanta, Georgia.
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Partially funded by a grant from Iomed Inc., Salt Lake City, Utah.
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Reprint requests: William T. Zempsky, MD, Division of Pediatric Emergency Medicine, Connecticut Children's Medical Center, 282 Washington St., Hartford, CT 06106.
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