https://journals.lww.com/clinicalpain/Fulltext/2015/10001/Far_From__Just_a_Poke___Common_Painful_Needle.3.aspx

A recent study found that 63% of children endorsed a fear of needles,²⁷ whereas several studies have reported adult prevalence rates of some degree of needle fear ranging from 14% to 38%

https://pubmed.ncbi.nlm.nih.gov/8956393/

EMLA cream effectively reduces the pain of spinal needle insertion

EMLA cream is an effective alternative to lidocaine infiltration for analgesia during the administration of spinal anesthesia when using a 25-gauge spinal needle via a 20-gauge introducer. Application of EMLA cream for at least 30 minutes prior to spinal needle insertion is adequate to provide good analgesia during needle insertion.

https://pubmed.ncbi.nlm.nih.gov/16856039/

https://pubmed.ncbi.nlm.nih.gov/2317421/

Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream

We have determined the depth and duration of analgesia to needle insertion after topical application of EMLA cream (Eutectic Mixture of Local Analgesics). EMLA was applied for 30, 60, 90 and 120 min and the sensory and pain threshold depths were determined before analgesia (1.0 and 1.9 mm, respectively) and up to 4 h after the cream was removed from the skin. The maximal depth of analgesia (approx. 5 mm) was observed 30 min after a 90-min application and during the 60-min period after a 120-min application of EMLA cream, for both sensory and pain thresholds. For application times shorter than 120 min, the depth of analgesia increased during the period after removal of the cream. This suggests new guidelines for the use of this topical analgesia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172821/

A hospital-wide initiative to eliminate or reduce needle pain in children using lean methodology

We chose to use 4% lidocaine cream63 

Objectives:

We implemented a hospital-based, system-wide initiative called the “Children's Comfort Promise,” and created a new standard of care for needle procedures that required staff to consistently offer 4 strategies: (1) topical anesthetics, (2) sucrose or breastfeeding for infants 0 to 12 months, (3) comfort positioning (including swaddling, skin-to-skin, or facilitated tucking for infants; sitting upright for children), and (4) age-appropriate distraction.

Methods:

The protocol was established system-wide in one of the largest children's hospitals in the United States using a staggered implementation approach over a 3-year period to allow for unit-specific customization and facilitation of knowledge transfer from one unit to another. All departments were required to offer all 4 strategies with appropriate education at least 95% of the time.

Results:

Comparison of baseline audits with continuous postimplementation audits revealed that wait times for services decreased, patient satisfaction increased, and staff concerns about implementation were allayed (eg, concerns about wait times and success rates of venipuncture after topical anesthesia).

Conclusion:

This is the first report of a successful system-wide protocol implementation to reduce or eliminate needle pain, including pain from vaccinations, in a children's hospital across all inpatient units, emergency departments, outpatient laboratories, and ambulatory clinics through consistent use of topical anesthesia, sucrose/breastfeeding, positioning, and distraction.

https://academic.oup.com/pch/article/24/8/509/5670802

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