Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e637-e643 (doi:10.1542/peds.2006-3351)

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ARTICLE

Routine Immunization Practices: Use of Topical Anesthetics and Oral Analgesics

Anna Taddio, PhD^a,b, Jennifer Manley, BA^a,b, Leah Potash, BA^a, Moshe Ipp, MD, FRCPC^c, Michael Sgro, MD, FRCPC^d, Vibhuti Shah, MD, FRCPC^e

^a Department of Pharmacy, Program in Child Health Evaluative Sciences
^c Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
^b Faculty of Pharmaceutical Sciences, University of Toronto, Toronto, Ontario, Canada
^d Department of Pediatrics, St Michael's Hospital, Toronto, Ontario, Canada
^e Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada

BACKGROUND. Immunization pain is a global public health issue. Despite an abundance of data that demonstrate the efficacy of local anesthetics for decreasing immunization pain, their adoption in practice has not been determined. Our objective was to evaluate analgesic use during childhood immunization.

PATIENTS AND METHODS. We used a cluster-sampling survey of pediatricians in the greater Toronto area (who administer immunizations) and multiparous women. By using a self-administered survey, pediatricians reported frequency of analgesic use in their practice for 2 phases of immunization: injection (needle puncture and vaccine administration) and postinjection (hours to days postvaccination). By using an interviewer-administered face-to-face survey, mothers reported analgesic practices for their children.

RESULTS. Of 195 eligible pediatricians, 140 (72%) responded. During the injection phase, 58% rarely or never used analgesics compared with 11% for the postinjection phase. During injection, the local anesthetics lidocaine-prilocaine and tetracaine were used at least sometimes in 12% and 2% of the practices, respectively, whereas acetaminophen and ibuprofen were used in 81% and 46%, respectively. Postinjection, acetaminophen and ibuprofen were used in 89% and 56% of practices. Of 257 eligible mothers, 200 (78%) participated. During injection, analgesics were used in 25% of immunizations (acetaminophen [87%], ibuprofen [7%], and lidocaine-prilocaine [6%]). Postinjection, analgesics were used in 33% of immunizations (acetaminophen [86%] and ibuprofen [14%]).

CONCLUSIONS. A minority of pediatricians and mothers use topical local anesthetics during childhood immunization despite evidence to support their use. Oral analgesics are used more commonly, but this practice is not consistent with scientific evidence. Knowledge-translation strategies are needed to increase the use of local anesthesia.

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Key Words: immunization • pain • infant-child • analgesia • acetaminophen • ibuprofen • lidocaine-prilocaine • amethocaine • survey

Abbreviations: GTA—greater Toronto area • OR—odds ratio • CI—confidence interval

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Accepted Jan 29, 2007.

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				C. Kemp Topical analgesics underused for immunization pain AAP News, December 1, 2007; 28(12): 2 - 2. [Full Text] [PDF]