A study of effect of topical anaesthetics on injection pain during immunization in infants

Authors

  • Magesh Kumar Department of Pediatrics, Military Hospital, Jodhpur, Rajasthan, India
  • V. Venkateshwar Consultant Pediatrician, NICE Hospital for Women, Newborn and Children, Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20202542

Keywords:

Immunization pain, Local anesthetics

Abstract

Background: Immunization is a necessary aspect of health care of children and injections are there for unavoidable. Many factors affect injection pain during immunization in infants. This study aims to see the effect of use of local anesthetics delivered by various modes for attenuation of vaccine related injection pain in infants and to compare them.

Methods: An Open Label Four-Arm Randomized Control Trial of 300 healthy infants of age group 6 weeks to 6 months reported to immunization clinic for immunization with DPT-HiB-Hepatitis B combination vaccine were taken for study. The enrolled subjects were allocated into control group and intervention group (who were applied some form of local anesthesia).

Results: Among the four groups of the patients studied we observed a statistical difference in the mean pain scores of the patients recorded at 15 second, 60 second and 5 min after vaccine injection (p value 0.0024 - 0.000). Group A (Infants with topical occlusive LA cream) showed minimum pain scores values at 15 second, 60 second and 5 min after vaccine injection, followed by Group C (Infants with topical LA spray with vapocoolant) whereas Control group (Infants not received any local anaesthesia) and Group B (Infants with topical LA spray without vapocoolant) exhibited the maximum pain scores.

Conclusions: Topical occlusive local anesthetic cream and topical LA spray with vapocoolent, were found to be better than topical LA spray without vapocoolant or no topical anesthetic. Use of topical occlusive LA cream led to a lowest pain score. There was no significant difference in the profile of side effects following injection in the four group.

References

Taddio A, Nulman I, Goldbach M, Ipp M, Koren G. Use of lidocainw-prilocaine cream for vaccination pain in infants. J Pediatr.1994;124:643-8.

Taddio A, Manley J, Potash L, Ipp M, Sgro M, Shah V. Routine immunization practices: use of topical anesthetics and oral analgesics. Pediatr. 2007 Sep 1;120(3):e637-43.

Jackson LA, Dunstan M, Starkovich P, Dunn J, Yu O, Nelson JC, et al. Prophylaxis with acetaminophen or ibuprofen for prevention of local reactions to the fifth diphtheria-tetanus toxoids-acellular pertussis vaccination: a randomized, controlled trial. Pediatr. 2006 Mar 1;117(3):620-5.

Reis EC, Holubkov R. Vapocoolant spray is equally effective as EMLA cream in reducing immunization pain in school-aged children. Pediatr. 1997;100(6):e5.

Taddio A, Nulman I, Koren BS, Stevens B, Koren G. A revised measure of acute pain in infants. J Pain Symptom Management. 1995 Aug 1;10(6):456-63.

O’Brien L, Taddio A, Ipp M, Goldbach M, Koren G. Topical 4% ametocaine gel reduces the pain of subcutaneous measles mumps rubella, vaccination. Pediatrics. 2004;114(6)

Halperin SA, McGrath P, Smith B, Houston T. Lidocaine-prilocaine patch decreases the pain associated with the subcutaneous administration of measles-mumps-rubella vaccine but does not adversely affect the antibody response. J Pediatr. 2000;136:789-94.

Halperin BA, Halperin SA, McGrath P, Smith B, Houston T. Use of lidocaine-prilocaine patch to decrease intramuscular injection pain does not adversely affect the antibody response to diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae type b conjugate and hepatitis B vaccines in infants from birth to six months of age. Pediatr Infect Dis J. 2000;21:399-405.

Cassidy KL, Reid GJ, McGrath PJ, Smith DJ, Brown TL, Finley GA. A randomized double-blind, placebo-controlled trial of the EMLA patch for the reduction of pain associated with intramuscular injection in four to six-year-old children. Acta Paediatr. 2001;90:1329-36.

Taddio A, Chambers C, Halperin S, Ipp M, Lockett D, Rieder MJ, et al. Inadequate pain management during childhood immunization: the nerve of it. Clin Ther. 2009;31(Suppl 2):S152-67.

Maikler VE. Effects of a skin refrigerant/anesthetic and age on the pain responses of infants receiving immunizations. Res Nurs Health. 1991;14(6):397-403.

Diekema DS. Improving childhood vaccination rates. N Engl J Med. 2012 Feb 2;366(5):391-3.

Mills E, Jadad AR, Ross C, Wilson K. Systematic review of qualitative studies exploring parental beliefs and attitudes toward childhood vaccination identifies common barriers to vaccination. J Clin Epidemiol. 2005;58:1081-8.

Geyer J, Ellsbury D, Kleiber C, Litwiller D, Hinton A, Yankowitz J. An evidence‐based multidisciplinary protocol for neonatal circumcision pain management. J Obstetr, Gynecol Neo Nurs. 2002 Jul;31(4):403-10.

Downloads

Published

2020-06-24

Issue

Section

Original Research Articles