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You are about to give a 2-month-old baby her first vaccinations. You wonder if there is a role for topical local anaesthetics in reducing pain from intramuscular injection of vaccinations.
Structured clinical question
In an infant undergoing intramuscular vaccination injection (patient) does topical local anaesthetic (intervention) compared with placebo (control) reduce pain (outcome).
Search MEDLINE: (intramuscular OR vacc* OR immuni*) AND (“local anaesthetic” OR EMLA OR Ametop OR tetracaine OR amethocaine OR eutectic) more than 90 results. Five studies excluded as patients were older than 2 years, two studies excluded as local anaesthetic cream was compared with another analgesic, not placebo, one study excluded as glucose was given at the same time as eutectic mixture of local anaesthetics (EMLA). Four studies included.⇓
Vaccination is the most common iatrogenic pain experienced by the normal child, and due to the number of vaccinations given to the entire population of infants, the magnitude of pain and distress experienced is extremely significant. Vaccine related pain, as perceived by parents and children, can be related to non-adherence with the vaccine schedule.5 However most …