Cochrane review: EMLA and Amethocaine for reduction of children's pain associated with needle insertion
Notice bibliographique
Résumé
Abstract Background Children often experience pain from needle insertion procedures; therefore, several topical anaesthetics have been developed. Objectives To compare the topical anaesthetics amethocaine and an eutectic mixture of local anaesthetics (EMLA) in terms of anaesthetic efficacy, ease of needle insertion and adverse events when used for intravenous cannulation and venipuncture in children. Search strategy An exhaustive search that included over 30 databases and handsearching reference lists and journals. Language restrictions were not imposed. Selection criteria Randomized controlled trials were selected that compared EMLA and amethocaine for relieving children's pain from intravenous cannulation or venipuncture. Data collection and analysis Two review authors independently determined eligibility for inclusion by assessing trial quality. Details of eligible studies were summarized. One author was contacted for additional information. Information about adverse events was obtained from the text of the trial reports. Review Manager 4.2 was used to perform a meta‐analysis and compute relative risks (RR) with 95% confidence intervals. Main results Six trials consisting of 534 children, three months to 15 years of age, were included in this review. A meta‐analysis was done comparing amethocaine with EMLA on anaesthetic efficacy, ease of needle procedure and resultant skin changes. For anaesthetic efficacy, amethocaine significantly reduced the risk of pain compared to EMLA when all pain data were combined into a common pain metric (RR 0.78, 95% CI 0.62 to 0.98); when pain was self‐reported by children (RR 0.63, 95% CI 0.45 to 0.87); or when pain was observed by researchers (sensitivity analysis: RR 0.71, 95% CI 0.52 to 0.96). Compared to EMLA, amethocaine significantly reduced the risk of pain when drugs were applied for the following durations: for 30 to 60 minutes (RR 0.61, 95% CI 0.41 to 0.91); when applied according to manufacturer's instructions (sensitivity analysis: RR 0.64, 95% CI 0.46 to 0.89); and when applied for over 60 minutes (RR 0.70, 95% CI 0.51 to 0.96). Amethocaine was also significantly more efficacious than EMLA when used specifically for intravenous cannulation (RR 0.70, 95% CI 0.55 to 0.88). Insufficient data were available to compare anaesthetic efficacy for venipuncture. A comparison of amethocaine and EMLA for ease of a needle procedure was not significant; only one trial reported data that could be included. For skin changes, EMLA was favoured in the analysis of erythema (RR 14.83, 95% CI 2.28 to 96.36). Erythema was observed after use of amethocaine whereas blanching was observed after using EMLA. Adverse effects included itching and one case of conjunctival irritation. Authors' conclusions Although EMLA is an effective topical anaesthetic for children, amethocaine is superior in preventing pain associated with needle procedures. Plain language summary Comparison of a eutectic mixture of local anaesthetics (EMLA) in a cream and amethocaine for relieving the pain children experience when they have needles. When children must give a blood specimen or have an intravenous drip inserted many feel pain. Drugs like EMLA and amethocaine have been developed to numb the skin and prevent or ease pain caused by needle insertion. EMLA is generally applied for 60 minutes before the procedure, whereas amethocaine is applied for 30 minutes before drawing a blood specimen and 45 minutes before insertion of an intravenous drip. Doctors, nurses and parents question which is better for relieving children's pain associated with needle insertion, EMLA or amethocaine? Also of importance is which of these drugs works best when recommended application times cannot be met? This review took six trials into account (534 children aged three months to 15 years). We considered how well EMLA and amethocaine eased pain from needles for three application times: when the drugs were applied for a short time, a long period of time and when applied for the recommended time. Although EMLA is effective in relieving children's pain amethocaine is superior no matter what the duration of time it is applied. Considering how well EMLA and amethocaine ease pain from giving blood specimens and having an intravenous drip inserted, we found that amethocaine is superior to EMLA for intravenous drip insertion. We were unable to compare EMLA and amethocaine for relieving children's pain when giving blood specimens because of a lack of research with this type of needle insertion.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,010 | 0,010 |
| Bibliométrie | 0,007 | 0,007 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».