Topical Anesthesia Use in Children

Kimberly A. Pesaturo, PharmD, BCPS; Michele Matthews, PharmD


US Pharmacist. 2009;34(3):HS-4- HS-7. 

In This Article


Approximately 70% of children feel fear, stress, or anxiety prior to a needlestick procedure or venipuncture.[1] Topical anesthetics are safe and effective for reducing the physical and emotional distress children may experience during these procedures, and they have been utilized for children in the emergency-department (ED) setting since the 1980s.[2] Although types of topical anesthetics have not changed considerably over the last few decades, several advances have been made in the technologies available for drug delivery.

Topical anesthetics reduce pain by inhibiting the transduction and transmission of nerve impulses.[3] This change occurs secondary to an alteration in transmission through voltage-sensitive sodium channels, resulting in a rise in the action-potential threshold. Traditional agents utilized as topical anesthetics for pediatric needlestick procedures include eutectic mixture of local anesthetics (EMLA), various lidocaine formulations, and vapocoolants. Newer agents and novel drug-delivery systems include lidocaine/tetracaine heating patches and pressurized lidocaine delivery systems (J-Tip, Zingo). This article will review the pharmacologic formulations available for use during venipuncture, needlestick procedures, and venous cannulation; it also will highlight their efficacy and safety when used in the pediatric population.


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