Prospective, Randomized, Double Blind Controlled Trial Comparing Vapocoolant Spray versus Placebo Spray in Adults Undergoing Venipuncture

Publication date: Available online 7 January 2016
Source:The American Journal of Emergency Medicine
Author(s): Sharon E. Mace
IntroductionTopical anesthetics are used to decrease procedural pain such as venipuncture. Advantages of vapocoolants include rapid onset, ease of application, low cost, and lack of associated pain of injection and other needle stick-related risks. We hypothesized that the pain of venipuncture would be reduced by at least 1.8 points on a 10-point numerical rating scale after application of a vapocoolant compared with placebo.MethodsWe conducted a prospective, randomized, double blind controlled trial of vapocoolant versus placebo spray in 100 adults (ages 18 – 80) requiring venipuncture in a hospital emergency department or observation unit. The primary efficacy outcome was the difference in pain scores immediately after venipuncture, measured on a 10-point verbal numeric rating scale from 0 (none) to worst Rodriguez and Jordan (2002) . Safety outcomes included local adverse effects (edema, erythema, blanching) and changes in vital signs.ResultsPatient characteristics and venipuncture procedure were not significantly different for the two groups. The median (inter-quartile range) pain of venipuncture was 3 (1.2-5) in the placebo group and 1 (0-3) in the vapocoolant group, P < 0.001. Skin checklist revealed vapocoolant: minimal blanching 4%, minimal erythema 18% which resolved within 5 minutes; placebo: no visible skin changes. Photographs at 5-10 minutes revealed no visible skin changes in any patient. Complaints were two: "very wet and cold on skin" (placebo) and "felt burning on skin" (vapocoolant).ConclusionThe vapocoolant significantly decreased venipuncture pain in adults compared with placebo and was well tolerated with minor side effects that resolved quickly. There were no significant differences in VS and no visible skin changes documented at the site by photographs taken within 5-10 minutes post spray/venipuncture.

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