Mitigating Procedural Pain during Venipuncture in the Pediatric Population: A Randomized Factorial Study

Purpose:

The purpose of this study was to determine if a there was a difference in the perceived pain associated with a venipuncture procedure in a group of pediatric patients based on the preparatory intervention used during the procedure and,  to determine if age, sex, or race were associated with the effectiveness of the preparatory interventions used.

Methods:

A quasi-experimental, 3x4 factorial design was used. Participants were recruited from a not for profit, regional hospital in the southeast United States. Participants were recruited from children between the ages of 18 months and 17 years who were admitted to the facility. The order had to be the first needle stick during admission with a parent or guardian present, who spoke English as the primary language. Potential participants were excluded if they had previous experience with any of the preparatory interventions, were sedated, unconscious, hemodynamically unstable, developmentally delayed for their age, or had a known chronic illness. Children were randomized to one of three treatment interventions. There was a purposeful effort to include representative numbers of each age group, sex, and race in each treatment group. Measures of pain included an observational measure completed by the parent/guardian and a self- report measure completed by the two older age groups both prior to and after the procedure.

Results:

Of the 285 participants consented to participate, 173 children completed the process including 35 (20.2%) toddlers, 34(19.7%) preschool  and 65 (37.6%) school age children, and 39 (22.5%) adolescents. There were 77 (44.5%) females and 96 (55.5%) males; and 101 (58.4%) Caucasian and 72 (41.6%)  Non-Caucasian children. There were no statistically significant differences among treatment groups based on the observational measures of pain or the self-report measures of pain. There was a statistically significant interaction between race and treatment group (p=0.006) based on the observational measure of pain which was also found between race and treatment group (p=.04) based on self-report scores in school age children and adolescents.

Conclusion:

Findings support the use of both mechanical vibration and topical anesthetic as effective in children regardless of age group or sex. Further, the interaction between race and treatment contributes to a growing body of knowledge that suggests race/ethnicity is not only an important factor in the pain response in children, but may also be important in the choice of treatments to minimize procedural pain related to venipuncture.