Version October 2024
| Start time before procedure (minutes) | |
| Behavioral methods* | |
| Preparation | 60¶ |
| Relaxation | 30¶ |
| Breathing | 2 and during procedure |
| Distraction | 2 and during procedure |
| Encourage coping | 2 and during procedure |
| Positioning | 2 and during procedure |
| Positive reinforcement | After procedure |
| Selected pharmacologic optionsΔ | |
| Lidocaine/prilocaine cream (eg, EMLA®) | 60 |
| Liposomal lidocaine (eg, LMX), heated lidocaine and tetracaine patch (Synera) or tetracaine gel (eg, Ametop◊) | 30 |
| Lidocaine iontophoresis | 15 |
| Needle-free lidocaine delivery | 2 |
| Lidocaine infiltration | 2 |
| Vapocoolant spray | 15 seconds |
| Nitrous oxide | <1 |
IV: intravenous.
* Continue all behavioral methods throughout the procedure, preferably by a dedicated child life specialist.
¶ For children undergoing urgent procedures, child life specialists can provide a reasonable degree of preparation and relaxation in patients within 15 to 20 minutes.
Δ The provider should select only one type of topical agent based upon available time prior to the procedure. Refer to UpToDate topics on topical analgesia during minor procedures. When properly maintained equipment and personnel are available and per caregiver and provider preference, nitrous oxide may be used to augment topical analgesia.
◊ Tetracaine gel is an ester type local anesthetic and is not commercially available in the United States. It is widely available elsewhere.Do you want to add Medilib to your home screen?
