Distraction techniques combined with EMLA: Effects on IV insertion pain and distress in children

The purpose of this study was to evaluate whether behavioral intervention (distraction techniques facilitated by nurses) could enhance the effectiveness of a eutectic mixture of local anesthetics for pediatric intravenous (IV) insertion. One hundred sixty children, ages 2 to 16 years and undergoing elective outpatient gastrointestinal endoscopy with IV sedation, participated in this study. Children were blocked by age group (2-4 years, 5-8 years, 9-12 years, and 13-16 years) and then randomly assigned to 1 of 2 experimental groups (distraction vs. instructions for parents and children to use their 'typical' strategies). Children of 5 years and older gave pain ratings (100 mm, Visual Analog Scale) following IV insertion. Behavioral distress ratings (0-5 numerical rating scale) were recorded before, at the point of, and following IV insertion. Additional data included child and parent anticipatory anxiety, previous IV experience and difficulty coping, and parent prediction of child distress during the IV insertion. Pain ratings were not influenced by the distraction intervention or by age group. Children's behavioral distress scores, however, were significantly lower for older children and for those children who were provided distraction. Children's anticipatory anxiety scores and parent predictions of children's distress were correlated with both pain ratings and behavioral distress scores. Results provide support for the integration of behavioral interventions with pharmacologic pain treatment with a primary benefit of decreased behavioral distress.