• Ramzi Hijazi, David Taylor, and Joanna Richardson.
• University of Melbourne, Parkville, Victoria, Australia 3052.
• BMJ. 2009 Jan 1;338:b215.

ObjectiveTo assess the efficacy, acceptability, and safety of a topical alkane vapocoolant in reducing pain during intravenous cannulation in adults.DesignRandomised double blind placebo controlled trial.SettingEmergency department of a metropolitan teaching hospital.Participants201 adult patients (54% male), mean (SD) age 58.2 (19.5) years, who required intravenous cannulation.InterventionsLess than 15 seconds before cannulation, the skin area 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 MeasuresPain with cannulation and discomfort with spray, measured with a 100 mm visual analogue scale.ResultsGroups did not differ significantly in age, sex, indication for or site of cannulation, cannula size, or who cannulated the patient (P>0.05). Median (interquartile range) pain scores for cannulation in the control and intervention groups were 36 (19-51) and 12 (5-40) mm, respectively (P<0.001), and 59 (60%) and 33 (32%) reported pain scores >or=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 between groups (P=0.39). Thirty four (39%) and 62 (62%) patients said they would choose the spray they received for analgesia in the future (P=0.002). At follow-up at five days, two patients in the intervention group reported transient skin redness.ConclusionsTopical alkane vapocoolant spray is effective, acceptable, and safe in reducing pain with peripheral intravenous cannulation in adults in the emergency department.Trial RegistrationAustralian Clinical Trials ACTRN12607000470493.

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