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

Needle-Free Pressurized Delivery Systems

Two single-use, needle-free anesthesia delivery systems have been introduced that allow for the rapid delivery of lidocaine hydrochloride prior to peripheral venous access procedures. The J-Tip device, introduced in 2001, uses compressed carbon dioxide for drug delivery into the subcutaneous space. It was initially designed for the needle-free delivery of insulin in patients with diabetes.[17] Currently, J-Tip is a delivery system only and must be filled by the user with the desired drug product (typically 1% or 2% buffered lidocaine powder). Introduced in 2007, Zingo is a prefilled syringe of sterile lidocaine powder 0.5 mg that uses pressurized helium to enable the drug to penetrate the epidermis.[18]

J-Tip and EMLA were compared in a head-to-head trial examining their efficacy in reducing pain during IV cannulation and placement.[19] Patients aged 7 to 19 years were randomized to receive 1% buffered lidocaine 0.25 mg via J-Tip (n = 57) or EMLA 2.5 g (n = 59) prior to cannulation. Pain was rated via visual analog scale scores (1-10) at the time of venous cannulation. Median pain score was 0 in the J-Tip group and 3 in the EMLA group (P =.0001). Although 40% of patients in the EMLA group had product-application times of less than the 60-minute recommendation, a subgroup analysis of those with proper EMLA administration further supported the superiority of J-Tip.

One phase III study examined venipuncture and venous cannulation pain after the use of Zingo in approximately 600 children aged 3 to 18 years.[20] This randomized, double-blind trial compared the delivery of lidocaine powder 0.5 mg via Zingo versus a sham placebo. Patients randomized to Zingo had significantly improved pain control compared with the placebo group. Twelve patients in the Zingo group experienced mild treatment-related adverse effects, including contusion and erythema.


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