Koh J L, Fanurik D, Stoner P D, Schmitz M L, VonLanthen M
Department of Anesthesiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202-3591, USA.
Pediatrics. 1999 Jun;103(6):e79. doi: 10.1542/peds.103.6.e79.
To demonstrate that parent application of eutectic mixture of local anesthetics (EMLA) results in equal reduction of the pain of intravenous (IV) placement compared with clinician application of EMLA, and to assess potential difficulties with parental application.
A 2 x 2 randomized block design was used, with 41 children divided into two age groups (5-12 years vs 13-18 years) and randomized to one of two experimental groups (parent-applied EMLA vs clinician-applied EMLA).
All children were scheduled to have outpatient gastrointestinal endoscopies with IV sedation. EMLA was placed at least 60 minutes before IV insertion either by the parent or a clinician, depending on the experimental group assignment. Outcome measures were child pain ratings and observed behavioral distress ratings. Parents and children were interviewed to determine parent and child anxiety levels in anticipation of the IV insertion, previous needle stick experience, and previous difficulty coping. Feasibility outcomes included technical difficulty with application of EMLA and appearance of the EMLA cream and occlusive covering.
Pain ratings and behavioral distress ratings in the low to moderate range for all groups and ws and were consistent w previous empiric reports of EMLA outcome. There were no significant differences in pain or distress ratings for either the age or the experimental groups. Parent ratings of their child's previous difficulty coping was related to the level of behavioral distress exhibited before (r =.50), during (r =.32) and after (r =.44) the IV insertion. In addition, children's anxiety ratings about IV insertion seemed to differ among groups (although not statistically significant for post hoc comparisons), with the most anxiety reported by the younger children when clinicians applied the EMLA and by older children when parents applied the EMLA.
Parent application of EMLA appears to be as effective as clinician application in reducing children's pain and distress associated with IV insertion. Permitting parents to apply the EMLA at home can allow children who are having procedures on an outpatient basis to benefit from topical anesthesia without having to arrive early to the clinic or hospital. Additionally, application by parents may result in less anticipatory anxiety for younger children.
证明家长涂抹局部麻醉剂的共熔混合物（EMLA）与临床医生涂抹EMLA相比，在减轻静脉穿刺疼痛方面效果相同，并评估家长涂抹的潜在困难。
采用2×2随机区组设计，41名儿童分为两个年龄组（5 - 12岁与13 - 18岁），并随机分配到两个实验组之一（家长涂抹EMLA组与临床医生涂抹EMLA组）。
所有儿童均计划接受门诊胃肠内镜检查并进行静脉镇静。根据实验组分配情况，在静脉穿刺前至少60分钟由家长或临床医生涂抹EMLA。观察指标为儿童疼痛评分和观察到的行为痛苦评分。对家长和儿童进行访谈，以确定他们在预期静脉穿刺时的焦虑水平、以往的针刺经历以及以往应对困难的情况。可行性指标包括涂抹EMLA的技术难度以及EMLA乳膏和封闭敷料的外观。
所有组的疼痛评分和行为痛苦评分均处于低至中等范围，与以往关于EMLA效果的经验性报告一致。年龄组和实验组在疼痛或痛苦评分方面均无显著差异。家长对其孩子以往应对困难的评分与静脉穿刺前（r = 0.50）、穿刺期间（r = 0.32）和穿刺后（r = 0.44）表现出的行为痛苦程度相关。此外，儿童对静脉穿刺的焦虑评分在各组之间似乎存在差异（尽管事后比较无统计学意义），在临床医生涂抹EMLA时，年幼儿童报告的焦虑最多；而在家长涂抹EMLA时，年长儿童报告的焦虑最多。
家长涂抹EMLA在减轻儿童静脉穿刺相关的疼痛和痛苦方面似乎与临床医生涂抹效果相同。允许家长在家中涂抹EMLA可使门诊接受检查的儿童受益于局部麻醉，而无需提前到达诊所或医院。此外，家长涂抹可能会减少年幼儿童的预期焦虑。
