Safety, Tolerability, and Efficacy of Iontophoresis with Lidocaine for Dermal Anesthesia in Emergency Department Pediatric Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/148350
Type:
Presentation
Title:
Safety, Tolerability, and Efficacy of Iontophoresis with Lidocaine for Dermal Anesthesia in Emergency Department Pediatric Patients
Abstract:
Safety, Tolerability, and Efficacy of Iontophoresis with Lidocaine for Dermal Anesthesia in Emergency Department Pediatric Patients
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:November 10 - 14, 2001
Author:Strout, Tania , RN, BSN
P.I. Institution Name:Maine Medical Center
Title:Research Nurse
Objective: To examine the safety, tolerability, and efficacy of iontophoresis with lidocaine for dermal anesthesia prior to placement of a peripheral intravenous catheter (PIV) in patients between the ages of 12 and 84 months. To evaluate the usefulness of a modified version of the Pre-Verbal, Early Verbal, Pediatric Pain Scale (PEPPS). Design: A prospective, IRB approved, descriptive study. Sample: Thirty-nine patients, 19 boys and 19 girls (median age 41 months). Setting: Level I emergency department. Names of Variables/Concept: Independent variable: Iontophoresis with 30 mAmin of lidocaine HCL2%: 1/100,000 epinephrine, a non-invasive system that uses a mild electrical current to achieve dermal anesthesia. It takes approximately 20 minutes in children. Outcome variables: Safety as indicated by serum lidocaine levels. Tolerability measured by tingling, redness, urticaria, blistering, blanching, and pain during the procedure. Efficacy as measured by pain at the time of needlestick. Measures/Instruments: Pain was measured in three ways. The modified PEPPS, with acceptable reliability and validity in assessing an established pain response, was used by the primary nurse provider at four points in time: prior to iontophoresis procedure, five minutes after its start, at the conclusion of the procedure, and at the time of the needlestick. Modified PEPPS scores can range from 0-20; scores < 6 are an acceptable level of pain. Children, who were able, self-reported on an ordinal 3-point scale at the same times. Parents marked their perceptions of the child’s pain on a 100 mm VAS, five minutes after the start of the procedure and at the time of the needlestick. Findings: Serum lidocaine levels were detectable but within normal laboratory reference range (n=23). One child (36 months) was unable to be distracted and did not complete the iontophoresis procedure. Side effects noted in 34 children were tingling, redness, and blanching at the site; one child had minor blistering. All side effects disappeared prior to discharge from the ED. 85% of the children had PEPPS scores < 6 at throughout the iontophoresis procedure. At the time of the needlestick, 42% had scores of < 6, with a range from 0 to 19. 82% of the parents marked the VAS at 30 or less five minutes after the start of the procedure; 65% indicated VAS pain scores of 30 or less at the time of the needlestick. Four of 14 children self-reported “a lot of pain” at the time of the needlestick. Although low to moderate, PEPPS scores and parental pain ratings were significantly correlated at both points in time (r=0.35; r=0.49). Conclusions: The preliminary findings suggest that the iontophoresis procedure is safe for use in children younger than seven years old. It did not create any long term untoward effects and was quite well tolerated by the children in this sample. Varied levels of pain were reported at the time of the needlestick. Further evaluation of the Modified PEPPS for assessing the immediate pain response is warranted. Implications: the iontophoresis procedure is completed in much less time than the 60 minutes required to achieve dermal anesthesia with prilocaine (EMLA). PEPPS scores and parental ratings are similar. It is not clear if the higher pain scores at the time of the needlestick reflect anxiety and fear of a needle or a painful experience. Further analysis by age will be reported.
Repository Posting Date:
26-Oct-2011
Date of Publication:
10-Nov-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleSafety, Tolerability, and Efficacy of Iontophoresis with Lidocaine for Dermal Anesthesia in Emergency Department Pediatric Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/148350-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Safety, Tolerability, and Efficacy of Iontophoresis with Lidocaine for Dermal Anesthesia in Emergency Department Pediatric Patients</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">November 10 - 14, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Strout, Tania , RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Maine Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Research Nurse</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">strout@mmc.org</td></tr><tr><td colspan="2" class="item-abstract">Objective: To examine the safety, tolerability, and efficacy of iontophoresis with lidocaine for dermal anesthesia prior to placement of a peripheral intravenous catheter (PIV) in patients between the ages of 12 and 84 months. To evaluate the usefulness of a modified version of the Pre-Verbal, Early Verbal, Pediatric Pain Scale (PEPPS). Design: A prospective, IRB approved, descriptive study. Sample: Thirty-nine patients, 19 boys and 19 girls (median age 41 months). Setting: Level I emergency department. Names of Variables/Concept: Independent variable: Iontophoresis with 30 mAmin of lidocaine HCL2%: 1/100,000 epinephrine, a non-invasive system that uses a mild electrical current to achieve dermal anesthesia. It takes approximately 20 minutes in children. Outcome variables: Safety as indicated by serum lidocaine levels. Tolerability measured by tingling, redness, urticaria, blistering, blanching, and pain during the procedure. Efficacy as measured by pain at the time of needlestick. Measures/Instruments: Pain was measured in three ways. The modified PEPPS, with acceptable reliability and validity in assessing an established pain response, was used by the primary nurse provider at four points in time: prior to iontophoresis procedure, five minutes after its start, at the conclusion of the procedure, and at the time of the needlestick. Modified PEPPS scores can range from 0-20; scores &lt; 6 are an acceptable level of pain. Children, who were able, self-reported on an ordinal 3-point scale at the same times. Parents marked their perceptions of the child&rsquo;s pain on a 100 mm VAS, five minutes after the start of the procedure and at the time of the needlestick. Findings: Serum lidocaine levels were detectable but within normal laboratory reference range (n=23). One child (36 months) was unable to be distracted and did not complete the iontophoresis procedure. Side effects noted in 34 children were tingling, redness, and blanching at the site; one child had minor blistering. All side effects disappeared prior to discharge from the ED. 85% of the children had PEPPS scores &lt; 6 at throughout the iontophoresis procedure. At the time of the needlestick, 42% had scores of &lt; 6, with a range from 0 to 19. 82% of the parents marked the VAS at 30 or less five minutes after the start of the procedure; 65% indicated VAS pain scores of 30 or less at the time of the needlestick. Four of 14 children self-reported &ldquo;a lot of pain&rdquo; at the time of the needlestick. Although low to moderate, PEPPS scores and parental pain ratings were significantly correlated at both points in time (r=0.35; r=0.49). Conclusions: The preliminary findings suggest that the iontophoresis procedure is safe for use in children younger than seven years old. It did not create any long term untoward effects and was quite well tolerated by the children in this sample. Varied levels of pain were reported at the time of the needlestick. Further evaluation of the Modified PEPPS for assessing the immediate pain response is warranted. Implications: the iontophoresis procedure is completed in much less time than the 60 minutes required to achieve dermal anesthesia with prilocaine (EMLA). PEPPS scores and parental ratings are similar. It is not clear if the higher pain scores at the time of the needlestick reflect anxiety and fear of a needle or a painful experience. Further analysis by age will be reported.</td></tr></table>en_GB
dc.date.available2011-10-26T09:43:53Z-
dc.date.issued2001-11-10en_GB
dc.date.accessioned2011-10-26T09:43:53Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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