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PEDIATRIC ANESTHESIA

EMLA Versus Nitrous Oxide for Venous Cannulation in Children

Olivier Paut, MD^*, Claire Calméjane, MD^*, Jean Delorme, PhD, Frédéric Lacroix, MD^*, and Jean Camboulives, MD^*

*Departments of Pediatric Anesthesia and Intensive Care and Pharmacy, La Timone University Hospital, Marseilles, France

Address correspondence and reprint requests to Olivier Paut, MD, Department of Pediatric Anesthesia and Intensive Care, La Timone University Hospital, Bd Jean Moulin, 13385 Marseilles Cedex 5, France. Address e-mail to opaut{at}ap-hm.fr

We compared EMLA cream with nitrous oxide (N₂O) for providing pain relief during venous cannulation in children. In a prospective, double-blinded, randomized study, 40 children, 6–11 yr, ASA status I or II, undergoing scheduled surgery received either EMLA cream and inhaled air and oxygen (Group EMLA) or a placebo cream and inhaled 70% N₂O in oxygen (Group N₂O) before venous cannulation. Pain was evaluated with a visual analog scale and the Objective Pain Scale. The ease of venous cannulation and the observer’s assessment of its efficacy for preventing pain were assessed. Heart rate, blood pressure, respiratory rate, and oxygen saturation were compared before and after venous cannulation. Visual analog scale scores (4.4 ± 7.5 vs 3.9 ± 9.3 mm, P = 0.85), Objective Pain Scale scores (median 0 [0–6] vs 0 [0–1], P = 0.61), efficacy (median 0 [0–1] vs 0 [0–1], P = 0.59), and ease of venous cannulation (0 [0–2] vs 0 [0–1], P = 0.84) were not different between EMLA and N₂O groups, respectively. There was no statistical difference between the groups for the physiologic variables. Minor side effects were significantly more common in the N₂O group (11 of 20) than in the EMLA group (7 of 20) (P = 0.0248). We conclude that both techniques provided adequate pain relief during venous cannulation, as demonstrated by the low pain scores.

IMPLICATIONS: We have evaluated nitrous oxide and EMLA cream for providing pain relief during venous cannulation in children at the induction of anesthesia. Both techniques provided adequate pain relief, and physiologic variables were not altered. Minor side effects were more common in the N₂O group.

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