1 of Table 6
Synthesis Table-6: Vapocoolant
Practice Area: Vapocoolant
Topic
Vapocoolant
and
topical
Citation
Reis, EC & Holubkov, R
Vapocoolant spray is equally effective
as EMLA cream in reducing
immunization pain in school-aged
children.
Pediatric , December 1997
Vol 10,
Sample
62 children 4-6
yrs of age
Pittsburgh
Primary Care
Clinics
Immunizations
Canadian
Preschool
4-5.5 yrs
Immunizations
90 children ( 51
boys-39 girls)
Key Findings
EMLA+distraction
Vapocoolant + Distraction
Distraction –blowing pinwheel
Similar pain scores with coolant
and EMLA. Videotapes and
observers found less distress
behaviors with both EMLA and
coolant. Children preferred
coolants. Adding topical to
distraction was better than
distraction alone.
Parents were willing to pay
Coolant, placebo, no treatment,
treatment. Less pain response in
treatment group. Placebo group
had less pain response also.
No relationship between parental
anxiety and child’s distress
Double Blind
study – placebo
control 60 - 2-6 mos
Routine DPT
Facial
expression, body
movement, and
cry = pain
Videotaped. All infants had
distress behaviors, those that had
topical displayed less distressed
behaviors. The treated infants
startled less and took longer to
cry.
RC clinical trial
Vapocoolant
Vapocoolant
Abbot, K and Fowler-Kerry, S
The use of a topical refrigerant
anesthetic to reduce injection pain in
children.
Journal of Pain and Symptom
Management, Nov 1995; 10, 8:584590.
Maikler, VE
Effects of a skin refrigerant anesthetic
and age on the pain responses of
infants receiving immunizations
Research in Nursing & Health 1991;
14, 397-403.
RCT
Comments
Vapocoolant is sprayed
on cotton ball and held
on site for 15 secondsallowed to evaporate for
1-2 seconds and then
cleaned with alcohol.
Vapor coolant is less
expensive and shorter
time to effect than EMLA.
Distraction + drug
Vapocoolant is effectiveUtilizing positive
suggestions “ This may
help the needle hurt less”
= cognitive pain relieving
strategy. Suggestion that
cotton ball would make it
better-placebo
Cotton ball-on skin for
10 seconds-give shot
immediately? if spray reduced
needle penetration only
and was not effective in
reducing deep muscle
pain
2 of Table 6
Vapo
coolant
Farion KJ, Splinter KL et al
The effect of vapocoolant spray on
pain due to intravenous cannulation in
children: a randomized controlled trial
CMAJ 2008 179(1) 31-6
Yoon, Wy, Churng SP et al Korea
Vapo
coolant
Vapo
coolant
Vapo
coolant
Analgesic pretreatment fro antibiotic
test; vapocoolant spray vs. ice cube
The American Journal of Emergency
Medicine 2008, 26, 59-61.
Ramshook C, Kozinetz CA, MoroSutherland, D
Efficacy of Ethyl chloride as a local
anesthetic for venipuncture and
intravenous cannulation insertion in a
pediatric emergency department
Pediatric Emergency Care 2001, 15
(5) 341-343.
Cohen LL, MacLaren, JE et al.
A randomized trial of vapocoolant for
pediatric immunization distress relief
Clin J Pain 2009 25(6) 490-494
Vapo
coolant
Hijazi R, Tayore D
Effect of topical alkane vapocoolant
spray on pain with intravenous
cannulation in patients in emergency
departments: randomized double blind
placebo controlled trail
BMJ 2009 online journal
6-12 yr 80 pts
urgent vascular
access ED
Double blind
RCT
Adult volunteers
20-55 yrs
50 subjects
each subject
received ice and
coolant
Cross over RCT
220 Children 3-18
Received anxiety
reducing
instruction from
child life
Child life available –provided
preparation and distraction
Anxiety and pain was measured
Coolant and placebo(saline) Used
15 mm as clinical difference in
pain
Subject felt ice was more
uncomfortable pretreatment,
but preferred ice as it
significantly decrease pain
No difference between the 2
treatments—groups stratified by
age. ? sample size adequate for
each group.
Sprayed from distance of
8-18 cm for 4-10 sec until
skin blanched
Coolant = less pain and
higher success rate
* excellent study
Ice in glove for 1
minute
Spray for 5 secs from a
distance of 15 cm until
skin just began to turn
white (manufacturer’s
instructions)
Spray fro 6 secs –
6inches
RCT
58 children
4-6 yrs
self report and
coded behavioral
observations
RCT
201 adult patients
RCT
Double blind
placebo
controlled
Coolant vs. standard
No difference between groups
Children sensitive to
temperature-cotton ball and
cold may have drawn attention
to procedure and increased
anxiety
Significant difference- coolant
decreased pain. There were
more patients with lower pain
scores
2 sprays = coolant vs. water
Cotton ball saturated and
left on site for 20 secs
Sprayed with water or
vapocoolants 12cm away
for 2 sec ( blend of
propane, butane, and
pentane) This product is
flammable
3 of Table 6
Vapo
coolant
Vapo
coolant
and topical
Costello
Ethyl vinyl chloride vapocoolant spray
fails to decrease pain associated with
intravenous cannulation in children
Clinical Pediatrics 2006 45:628-632
9-18yrs ; 3 groups
vapocoolant,
isopropyl spray or
no spray
127 subjects
Davies, EH & Molloy, A
Comparison of ethyl chloride spray
with topical anaesthetic in children
experiencing venepuncture
Paediatric Nursing 2006 18(3): 39-44
RCT
77 children
5-13 yrs
Preference given
to child for 3 rd
venipuncture
randomized cross
over trial- no
placebo
Vapocoolant
Vapo
Coolant
and topical
Preparation and distraction
provide to all 3 groups. Change of
13 was determined to be
significant. No measurable
difference between the 3 groups
No difference in pain scores
between the two
Spray is of equal preference to
Ametop
Third venipuncture was less
painful- ? related to child given
choice and knew what to expect
Zappa, SC & Nabors, SB
Survey to patients
Use of ethyl chloride topical anesthetic and parents
to reduce procedural pain in pediatric
oncology patients.
Cancer Nursing 1992 15: 130-136.
Parents and staff felt that children
had less pain. The majority of
children in all age groups reported
that the spray made the stick hurt
less. Parents reported
improvement in behaviors,
choices gave some control which
fostered cooperation and trust.
Soueid, A & Richards B
Ethyl chloride as acryoanalgesic in
pediatrics for venipuncture
Pediatric Emergency Care 2007 23(6)
380-383
Observation of current practice –
No differences between groups
3 grps:
vapocoolant,
Ametop, no
treatment-audit of
current practice
mean age = 9yrs
phlebotomist
assigned rx
Spray for up to 5 secuntil skin blanchedsuggested that longer
time might be needed.
Distraction and
preparation may have
been beneficial
8inches not exceeding
10 seconds- no more
than 45 second delay
between spray and
venipuncture
Ametop ( 30-45 minutes)
Younger children
preferred topical over
spray
? Optimum procedure
for spray.
Easy and effective.
What is the risk for
infection with accessing
port and spraying
coolant.? What is the
length of time that it is
effective. Causes
blanching of the skin for
5-30 seconds
Sprayed for 2 sec –
avoided frosting up –
allowed to evaporate for
10 secs. Area wiped off,
cannulation occurred
within 15 sec