During intensive and long-lasting treatments, short-term or emergency care, children often undergo minor needle-related procedures (ie, venepuncture, venous cannulation and puncture of central venous access ports). The use of topical analgesia topical analgesia before these procedures can reduce needle-related pain. There is, however, uncertainty about the type of local anaesthetic (ie, eutectic mixture of topical analgesia (EMLA) or tetracaine-containing creams (eg, Rapydan) that should be used.Therefore, a clinical practice guideline (CPG) was developed to establish a comprehensive, evidence-based overview and provide recommendations for clinical practice.A comprehensive multidisciplinary panel was assembled, comprising 16 professionals and patient representatives in the Netherlands. A systematic literature review was performed, and after dual appraisal of all articles, results were extracted and meta-analyses were performed. The Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess, extract and summarise the evidence. An in-person meeting was held to discuss the evidence, complete an evidence-to-decision framework and formulate recommendations.In total, ten randomised controlled trials comprising 1808 children formed the evidence base for the recommendations. We recommend the use of EMLA in children who need to undergo a minor needle-related procedure, with minimal application duration of 60 min (strong recommendation, very low-quality evidence). We suggest the use of tetracaine-containing creams only when rapid cannulation/puncture (ie, within 30-60 min) is required (weak recommendation, very low-quality evidence).In this CPG, we provide recommendations regarding the choice of local anaesthetic for needle-induced pain during minor procedures in children. With these recommendations, we aim to reduce procedural pain and thereby contribute to improving care for children.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
This is a clinical practice guideline on topical analgesia during needle-related procedures in children. A well-done systematic review gathered evidence followed by an evidence-to-decision framework to formulate recommendations. EMLA is recommended for children who need minor needle-related procedures, with a minimal application duration of 60 minutes, and tetracaine-containing creams only for rapid cannulation/puncture (ie, within 30–60 minutes).
Physician rater
This appears to be a well-done consensus statement, but it would have been helpful to have a pediatric emergency physician (perhaps non-existent in the Netherlands where the study was done) on the panel as I feel they may have under-weighted the importance of time-to-analgesia in their recommendations.
Physician rater
These guidelines on local anaesthetic gel use for needle-related procedures in children is very welcome and suggests using EMLA cream for procedures that have a window of 60 minutes and tetracaine-based creams for quicker procedures, 30-60 minutes. The need for a more rapid-onset locally applied analgesic / anaesthetic agent remains.
Physician rater
Working in the pediatric emergency department, we regularly need to perform needle-related procedures, so I know the topic evaluated in this review. At least in high-income countries, the information included in this article are known, but the diffusion of these practices is still underrepresented. This paper could represent a useful tool in this sense. Also, it was interesting to know that there is a paucity of data to be implemented.
, McMaster University