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Pain reduction in children during port-à-cath catheter puncture using local anaesthesia with EMLA™

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Abstract

Introduction

Alleviating pain is of high importance for children undergoing chemotherapy. Eutectic mixture of lidocain-prilocain cream (EMLA) is assumed to require 60 min application time.

Materials and methods

We prospectively compared the pain during port-à-cath punctures after 40 min compared to 60 min of application time. A prospective, unblinded, cross-over study was performed. The children received two punctures during their chemotherapy protocol. Patients in group 1 had the first puncture after 40 min EMLA application time. Their second puncture (approximately a week later) was done after 60 min. Patients in group 2 started after 40 min. Pain was scored using the visual analogue scale (VAS) and the Bieri scale. Patients, parents and a nurse scaled the pain after the intervention. Eighty-seven children between 2 and 18 years with different malignant diseases were included.

Results and discussion

On the VAS pain scale, the mean pain was 2.3 (minimum 0, maximum 9.2) after 40 min and 1.9 (minimum 0, maximum 9.4) after 60 min according to the observations of the nurse and very similarly according to the parents’ observations. The children expressed more pain after 40 min of EMLA application time (mean pain, 3.5) and a significant pain reduction after 60 min application time (mean pain 1.7).

Conclusion

In this study children experienced less pain after 60 min application time, but pain reduction was already seen after 40 min. The child’s perception of pain differed from observers’ point of view and should therefore always be included in pain management.

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Acknowledgements

The authors thank the patients and their families who participated in this trial, the physicians and nurses of the paediatric oncology ward for their input in performing this study. The authors also thank Annette Frank-Hoppe, Ute Nikolaizik and Christiane Schirmer for excellent study monitoring. Clemens Betzel is acknowledged for revising the manuscript.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Paediatric Haematology and Oncology, Medical University, Hannover, Germany

    Birke Lüllmann, Heidrun Gerr, Christin Linderkamp, Christoph Klein & Lorenz Grigull

  2. Department of Paediatric Surgery, St. Bernward Hospital, Hildesheim, Germany

    Johannes Leonhardt

  3. Department of Paediatric Surgery, Medical University, Hannover, Germany

    Martin Metzelder

  4. Department of Medical Statistics, Medical University, Hannover, Germany

    Ludwig Hoy

  5. Department of Paediatric Haematology and Oncology, OE 6780 Medizinische Hochschule Hannover, Carl-Neuberg Str. 1, 30625, Hannover, Germany

    Lorenz Grigull

Authors
  1. Birke Lüllmann
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  2. Johannes Leonhardt
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  3. Martin Metzelder
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  4. Ludwig Hoy
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  5. Heidrun Gerr
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  6. Christin Linderkamp
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  7. Christoph Klein
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  8. Lorenz Grigull
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Corresponding author

Correspondence to Lorenz Grigull.

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Lüllmann, B., Leonhardt, J., Metzelder, M. et al. Pain reduction in children during port-à-cath catheter puncture using local anaesthesia with EMLA™. Eur J Pediatr 169, 1465–1469 (2010). https://doi.org/10.1007/s00431-010-1244-1

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  • DOI: https://doi.org/10.1007/s00431-010-1244-1

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