Several products are commonly used to prevent pain from injections, finger pricks, IV insertions, and spinal taps. Most of these drugs fall into two categories, which are described below. Use of these drugs is also discussed in Chapter 6, Coping with Procedures.

Topical anesthetizing creams

Examples: EMLA®, ELA-Max®, and many other brand names

How given: Each product has slightly different instructions. In general, they are applied to the skin between 30 to 90 minutes before a procedure. Some must be covered with an airtight dressing.

How they work: These are creams that contain the topical anesthetic lidocaine. ELAMax® uses lidocaine alone; EMLA® uses lidocaine in combination with prilocaine.

Note: It may take longer than an hour to achieve effective anesthesia in dark-skinned children. When using EMLA®, sometimes the blood vessels constrict, making it harder to find a vein. To prevent this problem, it helps to apply a warm damp cloth immediately before the injection. For more information about use of these products, see Chapter 6, Coping with Procedures.

Vapocoolant sprays

Examples: Fluori-Methane Spray® and Fast Freeze®

How given: This aerosol spray is applied to the sterilized target area immediately before the procedure. It can also be applied by spraying the solution into a medicine cup for 10 seconds, then dipping a cotton ball into the solution and holding it on the site for 15 seconds immediately before the procedure.

How they work: Most vapocoolant sprays use the refrigerant ethyl chloride to numb the area before an injection or infusion.

Note: If the spray is applied too long, it can cause frostbite. Spray just until skin begins to turn white (3 to 10 seconds). The spray can should be held between 3 and 9 inches away from the skin.