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Open Access Highly Accessed Research article

How effective is tetracaine 4% gel, before a venipuncture, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial

Brigitte Lemyre1*, Debora L Hogan2, Isabelle Gaboury3, Rebecca Sherlock45, Colline Blanchard6 and David Moher137

Author affiliations

1 Department of Pediatrics, University of Ottawa, Ottawa, Canada

2 Department of Nursing, Children's Hospital of Eastern Ontario, Ottawa, Canada

3 Chalmers Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada

4 Department of Pediatrics, BC Children's and Women's Health Center, Vancouver, Canada

5 Department of Healthcare and Epidemiology, Faculty of Medicine, University of British Columbia, Vancouver, Canada

6 Department of Pharmacy, Children's Hospital of Eastern Ontario, Ottawa, Canada

7 Department of Epidemiology & Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada

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Citation and License

BMC Pediatrics 2007, 7:7  doi:10.1186/1471-2431-7-7

Published: 8 February 2007

Abstract

Background

Procedural pain relief is sub-optimal in neonates. Topical tetracaine provides pain relief in children. Evidence of its efficacy and safety in neonates is limited. The objective of this study was to assess the efficacy and safety of topical tetracaine on the pain response of neonates during a venipuncture.

Methods

Medically stable infants greater than or equal to 24 weeks gestation, requiring a venipuncture, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. Participants received oral sucrose if they met local eligibility criteria. The venipuncture was performed according to a standard protocol. A medium effect size in the pain score (corresponding to about 2 point difference in the PIPP score) was considered clinically significant, leading to a sample size of 142 infants, with 80% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test.

Results

One hundred and forty two infants were included, 33 +/- 4 weeks gestation, 2100 +/- 900 grams and 6 +/- 3 days of age. There was almost no difference in PIPP scores at 1 minute between groups (mean difference -0.09; 95% confidence interval [CI]: -1.68 to 1.50; P = . 91). Similarly, there were no differences in PIPP scores during the 2nd, 3rd and 4th minute. Duration of cry did not differ between the groups (median difference, 0; 95% CI, -3 to 0; P = . 84). The majority of infants in both groups received sucrose 24%. Sucrose had a significant effect on the PIPP score, as assessed by an ANOVA model (p = 0.0026). Local skin erythema was observed transiently in 11 infants (7 in the tetracaine and 4 in the placebo group). No serious side effect was observed.

Conclusion

Tetracaine did not significantly decrease procedural pain in infants undergoing a venipuncture, when used in combination with routine sucrose administration.