Skip to main content
SpringerLink
Log in

Randomized controlled trial of topical EMLA and vapocoolant spray for reducing pain during wDPT vaccination

  • Original Article
  • Published:
World Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Background

Intramuscular vaccination is among the most common source of iatrogenic pain in infants. Vapocoolant sprays are rapid-acting alternative to topical anesthetics. They provide transient anesthesia via evaporation induced skin cooling, and reduce pain due to vaccine injection in children and adults. The objective was to compare the synergistic analgesic effect of eutectic mixture of local anesthetics (EMLA) with breastfeeding (EB group) and vapocoolant spay with breastfeeding (VB group) to that of only breastfeeding (BO group) during whole cell diptheria, pertussis and tetanus (wDPT) vaccination.

Methods

A double blind randomized controlled trial was done to include infants up to 3 months of age who came for their first wDPT vaccination. The primary outcome variable was the duration of cry after vaccination. Secondary outcome variables were Modified Facial Coding Score, Neonatal Infant Pain Scale and latency of onset of cry.

Results

Of the 201 eligible participants, 111 babies were excluded and remaining 90 babies were randomized into three groups of thirty each. The groups did not differ significantly in baseline characteristics. Median (interquartile range, IQR) of duration of cry was lesser [35.86 (21.07-107.75) seconds] in babies receiving EMLA cream with breast feeding (EB group) and in babies receiving vapocoolant spray with breast feeding (VB group) [32.58 (21.25-106.21) seconds] as compared to babies receiving only breast feeding (BO group) [67.5 (27.6-180) seconds] (P=0.147). Difference in median (IQR) of latency of cry was not statistically significant. Modified Facial Coding Score and Neonatal Infant Pain Scale at 1 minute and 3 minutes was significantly lower in the EB and VB group, as compared to the BO group (P<0.05).

Conclusion

Addition of topical EMLA application or vapocoolant spray to breastfeeding during wDPT vaccination does not reduce duration of cry in infants up to 3 months of age. However, they are able to show reduction in pain score and further studies are warranted to assess their efficacy as pain relief measures in infants and children.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kennedy RM, Luhmann JD. Pharmacological management of pain and anxiety during emergency procedures in children. Paediatr Drugs 2001;3:337–354.

    Article  PubMed  CAS  Google Scholar 

  2. Iturriaga GS, Unceta-Barrenechea AA, Zárate KS, Olaechea IZ, Núñez AR, Rivero MM. Analgesic effect of breastfeeding when taking blood by heel-prick in newborns. An Pediatr (Barc). 2009;71:310–313.

    Article  PubMed  Google Scholar 

  3. Osinaike BB, Oyedeji AO, Adeoye OT, Dairo MD, Aderinto DA. Effect of breastfeeding during venepuncture in neonates. Ann Trop Paediatr 2007;27:201–205.

    Article  PubMed  CAS  Google Scholar 

  4. Efe E, Ozer ZC. The use of breast-feeding for pain relief during neonatal immunization injections. Appl Nurs Res 2007;20:10–16.

    Article  PubMed  Google Scholar 

  5. Shah PS, Aliwalas L, Shah V. Breastfeeding or breast milk to alleviate procedural pain in neonates: a systematic review. Breastfeed Med 2007;2:74–82.

    Article  PubMed  Google Scholar 

  6. Rosdahl I, Edmar B, Gisslen H, Nordin P, Lillieborg S. Curettage of molluscum contagiosum in children: analgesia by topical application of lidocaine/prilocaine cream (EMLA). Acta derm venereol 1998;68:149–153.

    Google Scholar 

  7. Taddio A, Nulman I, Goldbach M, Ipp M, Koren G. Use of lidocaine-prilocaine cream for vaccination pain in infants. J Pediatr 1994;124:643–648.

    Article  PubMed  CAS  Google Scholar 

  8. Uhari M. A eutectic mixture of lidocaine and prilocaine for alleviating vaccination pain in infants. Pediatrics 1993;92:719–721.

    PubMed  CAS  Google Scholar 

  9. Abbott K, Fowler-Kerry S. The use of a topical refrigerant anesthetic to reduce injection pain in children. J Pain 1995;10:584–590.

    CAS  Google Scholar 

  10. Cohen Reis E, Holubkov R. Vapocoolant spray is equally effective as EMLA cream in reducing immunization pain in school-aged children. Pediatrics 1997;100:E5.

    Article  PubMed  CAS  Google Scholar 

  11. Maikler VE. Effects of a skin refrigerant/anesthetic and age on the pain responses of infants receiving immunizations. Res Nurs Health 1991;14:397–403.

    Article  PubMed  CAS  Google Scholar 

  12. Gupta NK, Upadhyay A, Agarwal A, Goswami G, Kumar J, Sreenivas V. Randomized controlled trial of topical EMLA and breastfeeding for reducing pain during wDPT vaccination. Eur J Pediatr 2013;172:1527–1533.

    Article  PubMed  CAS  Google Scholar 

  13. Goswami G, Upadhyay A, Gupta NK, Chaudhry R, Chawla D, Sreenivas V. Comparison of analgesic effect of direct breastfeeding, oral 25% dextrose solution and placebo during 1st DPT vaccination in healthy term infants: a randomized, placebo controlled trial. Indian Pediatr 2013;50:649–653.

    Article  PubMed  Google Scholar 

  14. Singh VB, Mishra SK, Singh T, Upadhyay A. Antinociceptive effect of exclusive breast feeding in healthy term infants during vaccination. Early Hum Dev 2008;84:50–51.

    Google Scholar 

  15. Lindh V, Wiklund U, Blomquist HK, Håkansson S. EMLA cream and oral glucose for immunization pain in 3-month-old infants. Pain 2003;104:381–388.

    Article  PubMed  CAS  Google Scholar 

  16. Mawhorter S, Daugherty L, Ford A, Hughes R, Metzger D, Easley K. Topical vapocoolant quickly and effectively reduces vaccine-associated pain: results of a randomized, single-blinded, placebo-controlled study. J Travel Med 2004;11:267–272.

    Article  PubMed  Google Scholar 

  17. Farion KJ, Splinter KL, Newhook K, Gaboury I, Splinter WM. The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial. CMAJ 2008;179:31–36.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Hijazi R, Taylor D, Richardson J. Effect of topical alkane vapocoolant spray on pain with intravenous cannulation in patients in emergency departments: randomised double blind placebo controlled trial. BMJ 2009;338:b215.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Costello M, Ramundo M, Christopher NC, Powell KR. Ethyl vinyl chloride vapocoolant spray fails to decrease pain associated with intravenous cannulation in children. Clin Pediatr 2006;45:628–632.

    Article  Google Scholar 

  20. Ramsook C, Kozinetz CA, Moro-Sutherland D. Efficacy of ethyl chloride as a local anesthetic for venipuncture and intravenous cannula insertion in a pediatric emergency department. Pediatr Emerg Care 2001;17:341–343.

    Article  PubMed  CAS  Google Scholar 

  21. Upadhyay A, Aggarwal R, Narayan S, Joshi M, Paul VK, Deorari AK. Analgesic effect of expressed breast milk in procedural pain in term neonates: a randomized, placebo-controlled, double-blind trial. Acta Paediatr 2004;93:518–522.

    Article  PubMed  CAS  Google Scholar 

  22. Kataria M, Narang S, Chawla D, Sood S, Gupta PC. Oral dextrose for pain management during laser treatment of retinopathy of prematurity under topical anesthesia. Indian J Pediatr 2015;82:694–697.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, LLRM, Medical College, Meerut (UP), India

    Navratan Kumar Gupta, Amit Upadhyay, Ajeet Kumar Dwivedi, Astha Agarwal, Vijay Jaiswal & Abhishek Singh

Authors
  1. Navratan Kumar Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amit Upadhyay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ajeet Kumar Dwivedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Astha Agarwal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vijay Jaiswal
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abhishek Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amit Upadhyay.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gupta, N.K., Upadhyay, A., Dwivedi, A.K. et al. Randomized controlled trial of topical EMLA and vapocoolant spray for reducing pain during wDPT vaccination. World J Pediatr 13, 236–241 (2017). https://doi.org/10.1007/s12519-017-0004-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12519-017-0004-y

Keywords

Search

Navigation