Abstract
Introduction: Venipuncture is a common emergency department procedure that can cause discomfort and reduce patient satisfaction. This study compared the anesthetic effectiveness of lidocaine, diphenhydramine, and the lidocaine-prilocaine drug combination (EMLA cream) during venipuncture.
Methods: The study included 200 adult patients requiring venipuncture in the emergency department. Adult patients aged≥18 years were included and classified into four groups: 10% lidocaine, diphenhydramine syrup (60 ml bottle, with each 5 ml containing 12.5 mg of diphenhydramine), EMLA cream, and placebo (water). Patients with Glasgow Coma Scale (GCS)<15, severe pain, or requiring rapid vascular access were excluded. All substances, including the oral diphenhydramine syrup, were applied topically to the venipuncture site five minutes before venipuncture. Pain intensity was assessed immediately after the procedure using the Numeric Pain Rating Scale (NPRS). Data were analyzed using SPSS v21, with P<0.05 considered significant.
Results: There were no significant differences among the groups in age, sex, indication for venipuncture, or cannula gauge. Pain intensity differed significantly among the four groups (P<0.001). After Bonferroni adjustment, all active treatment groups had significantly lower pain scores than the control group (adjusted P<0.006), and EMLA was associated with significantly lower pain scores than both lidocaine and diphenhydramine (adjusted P<0.006). No significant difference was observed between the lidocaine and diphenhydramine groups (adjusted P>0.99). The median (IQR) NPRS scores for the control, lidocaine, diphenhydramine, and EMLA groups were 6 (6-7), 3 (2-3), 3 (2-3), 0 (0-0), respectively.
Conclusion: EMLA was associated with greater pain reduction during venipuncture compared with lidocaine and diphenhydramine, while no significant difference was observed between lidocaine and diphenhydramine. Further large-scale studies are needed to confirm these findings.