Ferayorni Angelique, Yniguez Robert, Bryson Matt, Bulloch Blake
Department of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ 85724-5057, USA.
Pediatr Emerg Care. 2012 Jul;28(7):687-90. doi: 10.1097/PEC.0b013e31825d210b.
Lumbar puncture (LP) is an essential procedure in the emergency department (ED) for the evaluation of meningitis. Subcutaneous injection of lidocaine before LP for local anesthesia is not a pain-free procedure. The J-Tip device allows an intradermal needle-free jet injection of 1% buffered lidocaine. This study compares needle-free jet injection of lidocaine to saline in reducing pain before LP in infants.
This is a randomized, double-blinded, placebo-controlled trial involving infants, younger than 3 months, presenting to the ED meeting clinical criteria for LP. All patients were administered the J-Tip and randomized to either treatment with 1% buffered lidocaine or an equivalent amount of sterile normal saline before LP. Vital signs were recorded during the procedure. Facial expressions as well as crying times were video recorded from start to finish. Independent reviewers assigned pain scores based on the validated Neonatal Facial Coding System with possible scores ranging from 0 to 5.
A total of 55 patients were enrolled. Mean (SD) pain scores at the time of needle insertion were 4.1 (1.3) for the lidocaine group and 4.8 (0.5) for the saline group (P = 0.01). Length of cry was also shorter for those in the lidocaine group, 38.5 versus 48.8 seconds (P = 0.04). Overall, κ was 0.76 between 2 independent reviewers.
Needle-free injection of 1% buffered lidocaine administered before needle insertion for LP in infants reduces pain and length of cry, compared with normal saline.
腰椎穿刺（LP）是急诊科评估脑膜炎的重要操作。LP前皮下注射利多卡因进行局部麻醉并非无痛操作。J-Tip装置可进行1%缓冲利多卡因的皮内无针喷射注射。本研究比较了利多卡因与生理盐水无针喷射注射在减轻婴儿LP前疼痛方面的效果。
这是一项随机、双盲、安慰剂对照试验，纳入了3个月以下因符合LP临床标准而就诊于急诊科的婴儿。所有患者均使用J-Tip装置，并在LP前随机分为接受1%缓冲利多卡因治疗或等量无菌生理盐水治疗。操作过程中记录生命体征。从开始到结束对面部表情和哭闹时间进行视频记录。独立评审员根据经过验证的新生儿面部编码系统评定疼痛评分，可能的评分范围为0至5分。
共纳入55例患者。利多卡因组穿刺时的平均（标准差）疼痛评分为4.1（1.3）分；生理盐水组为4.8（0.5）分（P = 0.01）。利多卡因组的哭闹时长也较短，分别为38.5秒和48.8秒（P = 0.04）。总体而言，两名独立评审员之间的κ值为0.76。
与生理盐水相比，婴儿LP穿刺前无针注射1%缓冲利多卡因可减轻疼痛和缩短哭闹时长。
