Comparison of the Use of the Valsalva Maneuver and the Eutectic Mixture of Local Anesthetics (EMLA®) to Relieve Venipuncture Pain: A Randomized Controlled Trial

Abstract

Purpose: Intravenous cannulation is a painful and stressful procedure. The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics (EMLA®) with that of the Valsalva maneuver in adult patients during i.v. cannulation. Methods: One hundred ninety-five patients were randomized prospectively to three groups. The dorsum of the nondominant hand was covered with a thick paste of 2.5 g of EMLA ® cream in the EMLA® group (group E) and left for a minimum of 30 min before venipuncture. In the control group (group C), the same procedure was applied except that Vaseline® was used instead of the EMLA®. The Valsalva group (group V) were punctured during a Valsalva maneuver. The patients were placed in the supine position during venipuncture. The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale (NRS; 0 = no pain, 10 = extreme pain). Results: Thirteen patients were excluded from the analysis due to failed cannulation. There was no difference in the demographic profiles of the groups (p > 0.05). The success of VP was significantly higher in group V than in groups E and C (p < 0.001). The median pain score as assessed by the NRS after venipuncture in group C was 3 (range 0-9), whereas the median pain values in groups E and V were 2 (range 0-7) and 2 (range 1-8). Conclusions: The Valsalva maneuver yields similar results to the EMLA® in terms of pain reduction during venipuncture. © 2012 Japanese Society of Anesthesiologists.