LIDOCAIN-PRILOCAIN CREAM AND GLUCOSE FOR VACCINATION PAIN IN THREE MONTH OLD INFANTS

Lindh V, Wiklund U, Blomquist HK, Håkansson S.

University Hospital of Northern Sweden, Umeå, Sweden

 

Objective: To determine whether use of lidocaine-prilocaine 5% cream (EMLA®) and glucose decreases pain associated with diphteria-pertussis-tetanus (DPT) vaccination in three month old infants.

Methods:Randomised, double-blind, controlled trial in outpatient pediatric practice in northern Sweden. EMLA® or placebo was applied to the infants leg and covered with an occlusive dressing one hour before the vaccination. In addition one ml glucose (300 mg/ml) or placebo (water) was dripped onto the babies tongue within two minutes before the DPT-injection. Fortyfive infants received EMLA® and glucose and 45 infants placebo cream and water. ECG was recorded and stored in a computer and the procedure was videotaped. The parents and the nurse assessed the infants pain on a visual anlogue scale (VAS) after the vaccination. Heartrate (HR) and heart rate variability (HRV) pre- and post-injection was calculated. From the videotapes the Modified Behavioral Pain Scale (MBPS) was used to assess pain scores during baseline and after vaccination. The latency to cry and total crying time were measured.

Results: The parents and the nurse scored the infants pain on the VAS significantly lower in the treatment group than in the placebo group.The infants responses to the vaccination, measured as the difference in MBPS-scorings pre- and post- injection were significantly lower in the EMLA®-glucose group compared to the placebo group. More infants cried after the vaccination in the placebo group compared to the EMLA® - glucose group. A biphasic transient HR response with a marked deceleration followed by a subsequent acceleration was seen more frequently in the placebo group compared to the EMLA® group.

Conclusion: EMLA® and glucose alleviate the vaccination pain in three month old infants

 

 
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