Anticipation, perception, and reality of pain are enough to cause most pediatric patients some level of anxiety and distress related to needle injections.
Preparing the patient on what to expect and on the use of an instant topical anesthetic are desirable before, or in place of, injection of local anesthetics to minimize anxiety associated with the threat of pain or the actual needle itself.
Whether it is a needlestick, sutures, or other minor medical procedures, pediatric patients, similar to adults, fear the unknown and anticipate pain sometimes even when an effective topical anesthetic is used. This is a situation that can be addressed with a few relatively easy preemptive actions.
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For example, simply explaining and showing how an instant topical anesthetic works — quickly and painlessly — gives the young patient power over the scary situation and gains the trust of the caregivers.
These are actions that are well within the scope of what a medical caregiver can do in virtually any pediatric procedure that involves needlesticks, suturing, and other minor procedures.
During international medical volunteer missions with the Global Smile Foundation, we have applied and benefited from an instant topical anesthetic to facilitate injection of local anesthetics into deeper tissue, allowing effective anesthesia and successful completion of uncomplicated cleft lip repairs without sedation in cooperative adolescents aged 12 to 18 years and in adult patients. Cleft lip surgery involves multiple local anesthetic injections (on average, 4), but it is the initial painful stick that is most hurtful and frightening.
Demonstrating to patients how an instant topical anesthetic works in dulling the sensation of a needle may lay the groundwork for building trust between the patient and operator. What we have learned from these experiences can unquestionably apply in other procedures in which young patients must deal with the physical and emotional discomfort associated with needle insertions.
Adolescents who have a severe fear (phobia) of needles require proper preparation, psychological support, and anxiolytics. In extreme cases, general anesthesia is necessary. Instant topical anesthetics can be helpful to relieve the pain of needlesticks, but fear of the needle is a very real psychological condition for even very brief painful injections such as vaccination or local anesthetic injection.
It is quite common for pediatric patients to fear needlesticks and medical procedures. Although it takes little time to demonstrate how instant topical anesthetics work—and even less time to apply — the payoff could be big.
Not only can the use of instant topical anesthetics ease pain and probably anxiety, it will enhance positive relations between patients and clinicians, as well as pave the way for effective communication, both of which are important for successful and safe completion of procedures. This may also mitigate the anticipatory anxiety with subsequent needle procedures.
Primary-care providers must consider the possible harm that needlesticks might cause to children and continue to find new opportunities to expand the use of instant topical anesthetics as a way to minimize the discomfort and fear of needle-related procedures.
Pain and distress resulting from needlesticks are also associated with unfavorable consequences such as lack of a patient’s cooperation during the procedure, leading to increased procedural time, reduced success, and diminished child and family satisfaction.
Navil F. Sethna, MD, FAAP, is the Senior Anesthesiologist and Clinical Director at the Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Waltham, Mass. He is a recipient of a grant for a laboratory study from Gebauer Company, the makers of Gebauer’s Pain Ease®. He was not compensated for this article.
