The Use of Vapocoolant in the Adult Population to Improve Patient Perception of Pain with Peripheral Intravascular Access

IMPORTANCE: Patient anxiety and perception of pain during peripheral intravenous (PIV) cannulation can unfavorably impact both patients and treatment provided. Topical analgesics are rarely used due to a long time to effectiveness and treatment delay, but vapocoolant has a more immediate effect. OBJECTIVE: To investigate whether the use of a topical vapocoolant anesthetic spray at the site of intravenous access reduces pain and anxiety associated with PIV insertion in an adult emergency room population. DESIGN, SETTING AND PARTICIPANTS: A randomized, doubleblind, placebo-controlled, single-center trial, conducted from July 2014 to August 2014 in an emergency department with 72 patients with orders for PIV placement receiving either topical vapocoolant spray (n=38) or a placebo spray (n=34). INTERVENTIONS: Vapocoolant spray or placebo was applied to the IV site and allowed to evaporate prior to cleansing and needle insertion. MAIN OUTCOMES AND MEASURES: The primary outcome was patient perception of pain and anxiety with PIV needle insertion using a 0-10 Likert scale. Secondary outcomes included patient/staff preference for the use of the topical anesthetic for future procedures and staff perception of the procedure and patient anxiety. RESULTS: The patient groups did not vary significantly in previous history of IV placement (p>0.999) nor anxiety pre-procedure (p=0.785). Median scores for patient perception of pain did not vary significantly between vapocoolant (2.0) and placebo populations (2.5), nor did the scores vary significantly for patient-forecasted anxiety regarding the procedure should the same procedure be used again (0.5 for vapocoolant, 0.0 for placebo; p>0.05). Additionally, when asked if they desired the spray for future procedures, nurses and patients responded identically: 89% expressed the desire for vapocoolant, while 74% desired future use of placebo; however, the difference was not significant (p>0.05). Neither placebo nor vapocoolant affected the nurses' ability to obtain IV access (p<0.05). No skin blanching or lesions due to the spray were noted. CONCLUSION: Among adult patients in the Parkland Emergency Department receiving PIV access, no significant differences in pain relief or alleviation of anxiety were found between treatment using a vapocoolant spray or placebo.