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