Comparison of the use of the Valsalva maneuver and the eutectic mixture of local anesthetics (EMLA®) to relieve venipuncture pain: a randomized controlled trial

• DOI: 10.1007/s00540-012-1540-1
• Publication Date: 2012-12-13T18:48:45Z
• Authors: Mustafa Suren; Ziya Kaya; Fatih Ozkan; Unal Erkorkmaz; Semih Arıcı; Serkan Karaman
• Keywords: Venipuncture; Valsalva maneuver; Pain medicine; Supine position; Prilocaine; Strapping

Intravenous cannulation is a painful and stressful procedure. The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics (EMLA(®)) with that of the Valsalva maneuver in adult patients during i.v. cannulation.One hundred ninety-five patients were randomized prospectively to three groups. The dorsum of the nondominant hand was covered with a thick paste of 2.5 g of EMLA(®) cream in the EMLA(®) group (group E) and left for a minimum of 30 min before venipuncture. In the control group (group C), the same procedure was applied except that Vaseline(®) was used instead of the EMLA(®). The Valsalva group (group V) were punctured during a Valsalva maneuver. The patients were placed in the supine position during venipuncture. The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale (NRS; 0 = no pain, 10 = extreme pain).Thirteen patients were excluded from the analysis due to failed cannulation. There was no difference in the demographic profiles of the groups (p > 0.05). The success of VP was significantly higher in group V than in groups E and C (p < 0.001). The median pain score as assessed by the NRS after venipuncture in group C was 3 (range 0-9), whereas the median pain values in groups E and V were 2 (range 0-7) and 2 (range 1-8).The Valsalva maneuver yields similar results to the EMLA(®) in terms of pain reduction during venipuncture.