Zweizeitige Anwendung von EMLA-Creme und GTN-Salbe zur schmerzlosen Venenpunktion bei Kindern

Problem: The use of EMLA-cream for painless vein-puncture with children causes a local vasoconstriction, so a successful puncture can be impeded (1). The addition of Glyceroltrinitrat (GTN) (2) improves the vein-filling, but neutralizes the analgesic effect (3). This lead to the investigation, whether the analgesic effect is maintained when EMLA-cream and GTN-ointment are applied at an interval of time. Method: After the official approval by the ethics committee we investigated 101 patients (age 2-14). All children received 2,5 g EMLA-cream onto the back of one hand 90 min before the vain-puncture under occlusion-film. The cream was wiped off after 60 min and on the same spot 4 mg GTN (ointment of 0,5%) was applied with one group (E+N, n=54), whereas placebo-cream was applied with the other group (E+P, n=47) 30 min before the puncture. Immediately before the puncture the degree of sedation, the local skin-reaction, number and visibility of the veins on the back of the hand were assessed; after the puncture its difficulty and the child�s reaction as well as the necessity of a second puncture were registered. Statistical analysis and evaluation: exact Fischer-test. Analysis: Both groups were equally divided with regard to sex, age and degree of sedation. Children of the E+N-group showed a skin turned pale (3,8%), unchanged skin (5,8%) and a skin turned red (90,4%) under the spot of application; the corresponding results of the E+P-group were 85,1%, 2,1% and 12,8% (p<0,001). At least one vein of the back of the hand was visible with 94,1% of the patients of the E+N-group, but only with 10,8% of the E+P-group (p<0,001). In the E+N-group the veins could be punctered very easily with 82,7%, normally with 9,6% and with difficulty with 7,7%. In the E+P-group the order was reverse (4,3%, 8,7% and 87,0%, p<0,001). 86,8% of the children with EMLA+GTN showed no, 9,4% a weak and 3,8% a strong reaction to the pain stimulus; the corresponding results in the EMLA+placebo-group were 78,7%, 14,9% and 6,4% Conclusion: The application of EMLA and GTN at an interval of time leads to a significantly improved filling of the veins of the back of the hand and to a high rate of successful punctures by neutralizing the local vein-constriction without losing the analgesic effect of EMLA-cream.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2000

Author dc:creator

• Ha-Phuoc, Hoang

Contributors dc:contributor

• Kalff, Günter

• info:eu-repo/classification/ddc/610
• Medizin

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-118533%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A56428