Comparison of Children's Venipuncture Fear and Pain: Randomized Controlled Trial of EMLA® and J-Tip Needleless Injection System®

Purpose Needle procedures, like venipuncture and intravenous (IV) catheter insertion, are recognized as a common cause of pain and fear for children in hospitals and emergency departments. The purpose of this study was to compare children's self-reported pain and fear related to IV insertion with administration of either the topical local anesthetic EMLA® or 1% buffered lidocaine delivered with the J-Tip Needleless Injection System® (J-Tip®). Design and Methods In this prospective, randomized trial, 150 consecutive pediatric patients 8 to 18 years of age undergoing IV insertion were randomly assigned 1:1 to treatment group. Participants self-reported procedural pain using a Visual Analog Scale, and procedural fear using the Children's Fear Scale. Results Procedural pain scores were significantly lower in the EMLA® group (mean score 1.63 + 1.659) vs. the J-Tip® group (2.99 ± 2.586; p < 0.001). Post-procedure fear scores were significantly lower than pre-procedure fear scores in both treatment groups (p < 0.002), but there was no difference in fear scores between the two treatment groups (p = 0.314). Conclusion EMLA® provided superior pain relief for IV insertion compared to J-Tip®. Practice Implications Although EMLA® use resulted in lower self-reported pain scores compared to J-Tip®, pain scores for both treatments were low and fear scores did not differ. When IV insertion can be delayed for 60–90 min, EMLA® should be used. When a delay is contraindicated, J-Tip® may be a reasonable alternative to minimize procedural pain of IV insertion.