UMEM Educational Pearls

Category: Pediatrics

Title: Analgesia in the Peds ED

Keywords: Analgesia, Oral Sucrose, topical lidocaine, Lumbar puncture (PubMed Search)

Posted: 4/4/2008 by Sean Fox, MD (Updated: 10/22/2019)
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Tips for Common Painful Procedures:

  • Remember, kids ARE just little adults: they feel pain just like the bigger people!
    • Don't let others convince you not to consider pain management for simple procedures because it is more convenient.
  • ORAL SUCROSE
    • Proven to reduce signs of distress in neonate (<1 month) for minor, painful procedures
    • Use in combination with sucking (ie, a pacifier).
    • Dose: 0.1ml of 24% to 2ml of 50% sucrose.
  • Topical Lidocaine Creams (LMX 4, EMLA)
    • Use for IV insertion (several studies has proven skilled triage nurses ar able to predict which children will need IVs)
    • Use for Lumbar Puncture!
      • Normally you most likely either ask someone with large muscles to hold the kid or you inject lidocaine, which can obscure your landmarks.
      • Instead, place LMX4 (takes ~20minutes to produce numbness) while you are documenting, getting consent, and setting up your equipment. 
      • This will give good anesthesia and keep the kid comfortable (ie, still) and not distort your landmarks... making you more likely to have success.
      • In neonates, you can also use Oral Sucrose Pacifer for added benefit.

References

EMSC Panel (Writing Committee) on Critical Issues in the Sedation of Pediatric Patients in the Emergency Clinical policy: Critical issues in the sedation of pediatric patients in the emergency department.  Ann Emerg Med. 2008 Apr;51(4):378-99, 399.e1-57