Effect of topical alkane vapocoolant spray on pain with intravenous cannulation in patients in emergency departments: randomised double blind placebo controlled trial

doi:10.1136/bmj.b215

Published 10 February 2009, doi:10.1136/bmj.b215
Cite this as: BMJ 2009;338:b215

Research

Effect of topical alkane vapocoolant spray on pain with intravenous cannulation in patients in emergency departments: randomised double blind placebo controlled trial

Ramzi Hijazi, medical student¹, David Taylor, director of emergency and general medicine research¹^,2, Joanna Richardson, staff specialist, emergency medicine²

¹ University of Melbourne, Parkville, Victoria, Australia 3052, ² Austin Health, Melbourne, Victoria, Australia 3084

Correspondence to: D Taylor David.Taylor{at}austin.org.au

Objective To assess the efficacy, acceptability, and safetyof a topical alkane vapocoolant in reducing pain during intravenouscannulation in adults.

Design Randomised double blind placebo controlled trial.

Setting Emergency department of a metropolitan teaching hospital.

Participants 201 adult patients (54% male), mean (SD) age 58.2(19.5) years, who required intravenous cannulation.

Interventions Less than 15 seconds before cannulation, the skinarea was sprayed with either water (control, n=98) or vapocoolant(intervention, n=103), from a distance of 12 cm for 2 seconds.The intervention spray was a blend of propane, butane, and pentane.

Main outcome measures Pain with cannulation and discomfort withspray, measured with a 100 mm visual analogue scale.

Results Groups did not differ significantly in age, sex, indicationfor or site of cannulation, cannula size, or who cannulatedthe patient (P>0.05). Median (interquartile range) pain scoresfor cannulation in the control and intervention groups were36 (19-51) and 12 (5-40) mm, respectively (P<0.001), and59 (60%) and 33 (32%) reported pain scores $≥$ 30 mm (P<0.001).Scores for spray discomfort also differed significantly (P<0.001)because of skewing to the right within the intervention group.The median discomfort scores, however, were 0 mm in both groups.Success rates for first cannulation attempt did not differ betweengroups (P=0.39). Thirty four (39%) and 62 (62%) patients saidthey would choose the spray they received for analgesia in thefuture (P=0.002). At follow-up at five days, two patients inthe intervention group reported transient skin redness.

Conclusions Topical alkane vapocoolant spray is effective, acceptable,and safe in reducing pain with peripheral intravenous cannulationin adults in the emergency department.

Trial registration Australian Clinical Trials ACTRN12607000470493.

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Relevant Article

Minimising pain during intravenous cannulation: Andrew Moore, Sebastian Straube, and Henry McQuay
BMJ 2009 338: a2993. [Extract] [Full Text]

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Moore, A., Straube, S., McQuay, H. (2009). Minimising pain during intravenous cannulation. BMJ 338: a2993-a2993 [Full text]