• Marc Auerbach, Michael Tunik, and Michael Mojica.
• Department of Pediatrics, Division of Pediatric Emergency Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY, USA. marc.auerbach@nyumc.org
• Acad Emerg Med. 2009 May 1;16(5):388-93.

ObjectivesThe objectives were to determine whether pretreatment with needleless jet-delivered lidocaine decreases self-reported pain in children undergoing needle insertion in the emergency department (ED) and to explore whether pretreatment with a jet device decreases self-reported pain in children undergoing needle insertion in the ED.MethodsThis study examined needle insertion pain in children 5-18 years of age. In the first phase of this study, children received either pretreatment with jet-delivered lidocaine (0.2 mL of buffered 1% lidocaine; n = 75) or pretreatment with jet-delivered placebo (0.2 mL of preservative-free normal saline; n = 75) 60 seconds before undergoing needle insertion. This phase of the study had a randomized, double-blind, placebo-controlled design. In the second phase, an unblinded, nonconcurrent, nonintervention control group (n = 47) was examined to describe any effect of using the jet device. Patients reported pain upon administration of the jet device and at needle insertion using a 100-mm color analog scale (CAS). Patients also reported their satisfaction with this device. The physicians and nurses performing needle insertions were asked to rate their ability to visualize the vein and their satisfaction with the device.ResultsThe mean (+/-standard deviation [SD]) needle insertion pain score for jet lidocaine, 28 (+/-7) mm, was similar to the mean needle insertion pain score for jet placebo, 34 (+/-7) mm. The mean needle insertion pain score for both the jet lidocaine and the jet placebo groups were lower than the needle insertion pain scores for the no device group, 52 (+/-8) mm. The majority of patients receiving the jet device reported that they would request this device for future needle insertions. Providers' ratings of their ability to visualize veins and the patient cooperation were similar in all three groups.ConclusionsJet-delivered lidocaine is no more effective than jet-delivered placebo in providing local anesthesia for needle insertion. Jet lidocaine and jet placebo may provide superior analgesia compared to no local anesthetic pretreatment.

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