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Needle-Free Delivery of Lidocaine

A needle-free delivery system holds promise as a pain-reducing intervention in children during venous procedures.

Various options are available for local anesthesia prior to venipuncture, but onset of action often is slow. In an industry-supported, multicenter, randomized trial, 579 hospitalized children (age range, 3–18 years) who were undergoing venipuncture or intravenous cannulation received treatment with either a needle-free powder lidocaine delivery system (helium gas releases lidocaine from a cylinder into the epidermis) or a sham–placebo-delivery system 1 to 3 minutes before the procedure.

The success rate of venous procedures on the first attempt was about 96% in both the treatment and sham groups. Mean pain scores immediately after administration, as assessed by patients on a pain-rating scale using facial expressions (0 = no hurt to 5 = hurts worst), were low in both the treatment and sham groups (0.54 vs. 0.24). After the procedure, mean pain scores were significantly lower in the treatment group on the faces scale (1.77 vs. 2.10) and on a visual analog scale assessed by children aged 8 and older and by parents. The number of treatment-related adverse events was similar in the two groups (12 and 9, respectively) and included three events of moderate severity in the treatment group (bruising, cellulitis, and contusion).

Comment: This needle-free delivery system holds promise as a pain-reducing intervention in children undergoing various procedures. The device seems to work quickly, to reduce pain, and to not affect the success rate of venous procedures.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine May 28, 2008

Citation(s):

Zempsky WT et al. Needle-free powder lidocaine delivery system provides rapid effective analgesia for venipuncture or cannulation pain in children: Randomized, double-blind Comparison of Venipuncture and Venous Cannulation Pain After Fast-Onset Needle-Free Powder Lidocaine or Placebo Treatment trial. Pediatrics 2008 May; 121:979.

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