CMAJ • July 1, 2008; 179 (1). doi:10.1503/cmaj.070874.
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Research

The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial

Ken J. Farion, MD, Karen L. Splinter, MD, Kym Newhook, BScN RN, Isabelle Gaboury, MSc and William M. Splinter, MD

From the Departments of Pediatrics (Farion), Emergency Medicine (Farion) and Anesthesiology (K.L. Splinter, W.M. Splinter), University of Ottawa; the Emergency Department (Newhook), Children's Hospital of Eastern Ontario; and the Children's Hospital of Eastern Ontario Research Institute (Gaboury), Ottawa, Ont

Correspondence to: Dr. William M. Splinter, Department of Anesthesiology, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Ottawa ON K1H 8L1; fax 613 738-4815; splinter{at}cheo.on.ca

Background: Established noninvasive pharmacologic means of alleviating pain and anxiety in children undergoing intravenous cannulation are time-consuming, and thus impractical for routine use in the emergency department. Vapocoolant sprays provide transient skin anesthesia within seconds of application. We compared the effect of a new vapocoolant spray to placebo on pain due to intravenous cannulation in children.

Methods: In this double-blind randomized controlled trial, which we conducted between June 1 and Sept. 12, 2006, 80 children aged 6–12 years received either vapocoolant spray or placebo before cannulation. Children rated their pain using a 100-mm colour visual analogue scale. Secondary outcomes included success rate on first attempt at cannulation and pain ratings by the children's parents, nurses and child life specialists.

Results: We found a modest but significant reduction in pain with the use of vapocoolant spray (mean difference 19 mm, 95% confidence interval [CI] 6–32 mm; p < 0.01). Cannulation on first attempt was more often successful with the use of vapocoolant spray (85.0%) than with placebo (62.5%) (mean difference 22.5%, 95% CI 3.2%–39.9%; p = 0.03). The number needed to treat to prevent 1 cannulation failure was 5 (95% CI 3–32). Parents (p = 0.04), nurses (p = 0.01) and child life specialists (p < 0.01) considered the children's pain to be reduced with the use of vapocoolant spray.

Interpretation: The vapocoolant spray in our study quickly and effectively reduced pain due to intravenous cannulation in children and improved the success rate of cannulation. It is an important option to reduce childhood procedural pain in emergency situations, especially when time precludes traditional interventions.

(http://ClinicalTrials.gov trial register no. NCT00130650.)


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eLetters:

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Re: vapocoolant spray
James H. Battershill
CMAJ, 4 Jul 2008 [Full text]