1

of Table 6

Synthesis Table-6: Vapocoolant

Practice Area: Vapocoolant

Topic / Citation / Sample / Key Findings / Comments
Vapo-coolant
and topical / Reis, EC & Holubkov, R
Vapocoolant spray is equally effective as EMLA cream in reducing immunization pain in school-aged children.
Pediatric , December 1997
Vol 10, / 62 children 4-6 yrs of age
Pittsburgh Primary Care Clinics
Immunizations
RC clinical trial / EMLA+distraction
Vapocoolant + Distraction
Distraction –blowing pinwheel
Similar pain scores with coolant and EMLA. Videotapes and observers found less distress behaviors with both EMLA and coolant. Children preferred coolants. Adding topical to distraction was better than distraction alone.
Parents were willing to pay / Vapocoolant is sprayed on cotton ball and held on site for 15 seconds-allowed to evaporate for 1-2 seconds and then cleaned with alcohol. Vapor coolant is less expensive and shorter time to effect than EMLA.
Distraction + drug
Vapo-coolant / Abbot, K and Fowler-Kerry, S
The use of a topical refrigerant anesthetic to reduce injection pain in children.
Journal of Pain and Symptom Management, Nov 1995; 10, 8:584-590. / Canadian
Preschool
4-5.5 yrs
Immunizations
90 children ( 51 boys-39 girls)
Double Blind study – placebo control - / Coolant, placebo, no treatment, treatment. Less pain response in treatment group. Placebo group had less pain response also.
No relationship between parental anxiety and child’s distress / Vapocoolant is effective- Utilizing positive suggestions “ This may help the needle hurt less” = cognitive pain relieving strategy.Suggestion that cotton ball would make it better-placebo
Cotton ball-on skin for 10 seconds-give shot immediately-
Vapo-coolant / Maikler, VE
Effects of a skin refrigerant anesthetic and age on the pain responses of infants receiving immunizations
Research in Nursing & Health 1991; 14, 397-403. / 60 - 2-6 mos
Routine DPT
Facial expression, body movement, and cry = pain
RCT / Videotaped. All infants had distress behaviors, those that had topical displayed less distressed behaviors. The treated infants startled less and took longer to cry. / ? if spray reduced needle penetration only and was not effective in reducing deep muscle pain
Vapo
coolant / Farion KJ, Splinter KL et al
The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial
CMAJ 2008 179(1) 31-6 / 6-12 yr 80 pts urgent vascular access ED
Double blind
RCT / Child life available –provided preparation and distraction
Anxiety and pain was measured
Coolant and placebo(saline) Used 15 mm as clinical difference in pain / Sprayed from distance of 8-18 cm for 4-10 sec until skin blanched
Coolant = less pain and higher success rate
* excellent study
Vapo
coolant / Yoon, Wy, Churng SP et al Korea
Analgesic pretreatment fro antibiotic test; vapocoolant spray vs. ice cube
The American Journal of Emergency Medicine 2008, 26, 59-61. / Adult volunteers 20-55 yrs
50 subjects
each subject received ice and coolant
Cross over RCT / Subject felt ice was more uncomfortable pretreatment, but preferred ice as it significantly decrease pain / Ice in glove for 1 minute
Spray for 5 secs from a distance of 15 cm until skin just began to turn white (manufacturer’s instructions)
Vapo
coolant / Ramshook C, Kozinetz CA, Moro-Sutherland, D
Efficacy of Ethyl chloride as a local anesthetic for venipuncture and intravenous cannulation insertion in a pediatric emergency department
Pediatric Emergency Care 2001, 15 (5) 341-343. / 220 Children 3-18
Received anxiety reducing instruction from child life
RCT / No difference between the 2 treatments—groups stratified by age. ? sample size adequate for each group. / Spray fro 6 secs – 6inches
Vapo
coolant / Cohen LL, MacLaren, JE et al.
A randomized trial of vapocoolant for pediatric immunization distress relief
Clin J Pain 2009 25(6) 490-494 / 58 children
4-6 yrs
self report and coded behavioral observations
RCT / Coolant vs. standard
No difference between groups
Children sensitive to temperature-cotton ball and cold may have drawn attention to procedure and increased anxiety / Cotton ball saturated and left on site for 20 secs
Vapo
coolant / Hijazi R, Tayore D
Effect of topical alkane vapocoolant spray on pain with intravenous cannulation in patients in emergency departments: randomized double blind placebo controlled trail
BMJ 2009 online journal / 201 adult patients
RCT
Double blind placebo controlled / Significant difference- coolant decreased pain. There were more patients with lower pain scores
2 sprays = coolant vs. water / Sprayed with water or vapocoolants 12cm away for 2 sec ( blend of propane, butane, and pentane) This product is flammable
Vapo
coolant / Costello
Ethyl vinyl chloride vapocoolant spray fails to decrease pain associated with intravenous cannulation in children
Clinical Pediatrics 2006 45:628-632 / 9-18yrs ; 3 groups vapocoolant, isopropyl spray or no spray
127 subjects
RCT / Preparation and distraction provide to all 3 groups. Change of 13 was determined to be significant. No measurable difference between the 3 groups / Spray for up to 5 sec- until skin blanched- suggested that longer time might be needed. Distraction and preparation may have been beneficial
Vapo coolant and topical / Davies, EH & Molloy, A
Comparison of ethyl chloride spray with topical anaesthetic in children experiencing venepuncture
Paediatric Nursing 2006 18(3): 39-44 / 77 children
5-13 yrs
Preference given to child for 3 rd venipuncture
randomized cross over trial- no placebo / No difference in pain scores between the two
Spray is of equal preference to Ametop
Third venipuncture was less painful- ? related to child given choice and knew what to expect / 8inches not exceeding 10 seconds- no more than 45 second delay between spray and venipuncture
Ametop ( 30-45 minutes)
Younger children preferred topical over spray
? Optimum procedure for spray.
Vapo-coolant / Zappa, SC & Nabors, SB
Use of ethyl chloride topical anesthetic to reduce procedural pain in pediatric oncology patients.
Cancer Nursing 1992 15: 130-136. / Survey to patients and parents / Parents and staff felt that children had less pain. The majority of children in all age groups reported that the spray made the stick hurt less. Parents reported
improvement in behaviors, choices gave some control which fostered cooperation and trust. / Easy and effective.
What is the risk for infection with accessing port and spraying coolant.? What is the length of time that it is effective. Causes blanching of the skin for 5-30 seconds
Vapo
Coolant and topical / Soueid, A & Richards B
Ethyl chloride as acryoanalgesic in pediatrics for venipuncture
Pediatric Emergency Care 2007 23(6) 380-383 / 3 grps: vapocoolant, Ametop, no treatment-audit of current practice
mean age = 9yrs
phlebotomist assigned rx / Observation of current practice – No differences between groups / Sprayed for 2 sec –avoided frosting up –allowed to evaporate for 10 secs. Area wiped off, cannulation occurred within 15 sec