Commentary

Clinical practice guidelines on acute pain management from 1 of the many national bodies (Agency for Healthcare Research and Quality—formerly the Agency for Policy and Healthcare Research) stipulate that appropriate relief for painful paediatric procedures should address both pain and anxiety using pharmacological and non-pharmacological methods.¹ Clinical practice and medical literature indicate that pain, especially in children, remains under-recognised and inadequately treated. Demands for efficiency and cost savings in the outpatient setting often take priority over appropriate pain management. Therefore, techniques for reducing pain must be cost effective, have a rapid onset, and be acceptable to children and their parents.

The study by Migdal et al shows that pain associated with venipuncture can be reduced using powdered lidocaine (0.5 mg) delivered by pressurised helium gas. The technique provides rapid onset of local anaesthesia, making it useful for venipuncture in an outpatient setting.

The rapid onset of local anaesthesia within 2–3 minutes makes this technique more useful than liposomal lidocaine, which has an onset of 20 minutes, and eutectic mixture of local anaesthetics (EMLA) with occlusion, which has an onset of 45 minutes. Lidocaine iontophoresis provides excellent local anaesthesia <10 minutes but was described as unpleasant by 5% of children.² Migdal et al do not comment on children’s perceptions of their technique or whether any of the children experienced this technique as unpleasant. Likewise, they do not comment on non-pharmacological techniques that may have been used to augment the efficacy of their technique. Vapocoolant sprays combined with distraction have a rapid onset (<1 min), are inexpensive, and are effective in reducing pain associated with immunisations and venipuncture. The efficacy and cost effectiveness of using pressurised powdered lidocaine over vapocoolant sprays remains unknown.