New topical pain cream, Maxilene, eases procedural pain

Researchers at The Hospital for Sick Children (Sick Kids) have found that a new topical anaesthetic (liposomal lidocaine 4% cream, brand name Maxilene) effectively reduced pain for children having IVs inserted (cannulation) in the emergency department and improved procedural success rates.

This research is reported in the June 21, 2005 issue of the Canadian Medical Association Journal (CMAJ).

"Children and parents often cite procedural pain as the most distressing part of their child's hospitalization. Previous studies have shown that topical local anaesthetics can decrease pain, but there was concern that they could interfere with the ability of health-care providers to perform the procedures themselves, leading to an increase in the overall number of procedures and therefore more pain," said Dr. Anna Taddio, the study's lead author and principal investigator, a Sick Kids scientist and pharmacist, and an assistant professor of Pharmacy at the University of Toronto.

"In this study, we showed that the topical local anaesthetic liposomal lidocaine not only decreased pain during IV cannulation, but actually facilitated the procedure," Dr. Taddio added. "Based on these results, we would recommend implementing its use as a routine part of every cannulation procedure. Not only will children benefit from less pain and less procedures, but children, their parents and health-care workers will have less stress during procedures as well."

The study was a double-blind randomized control trial in the Sick Kids Emergency Department, where children aged one month to 17 years who required an IV insertion received either the liposomal lidocaine cream or a placebo before the procedure. IVs were successfully inserted on first attempt in 74 per cent of the children who received the liposomal lidocaine, and in 55 per cent of those who received the placebo. Lower pain scores were also reported for the group who received the liposomal lidocaine cream.

Other members of the research team included Dr. Dennis Scolnik, Dr. Gideon Koren, Dr. Suzanne Schuh and Herpreet Kaur Soin, all from Sick Kids.

This research was supported by Sick Kids Foundation, a Canadian Institutes of Health Research (CIHR) New Investigator Award to Dr. Taddio and a CIHR Senior Investigator Award to Dr. Koren. Ferndale Laboratories provided liposomal lidocaine and placebo study medications. The Canadian distributor of liposomal lidocaine, RGR Pharma, also provided funding for the pharmacy dispensing costs.

http://www.utoronto.ca/ and http://www.sickkids.ca/