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

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. One hundred ninety-five patients were randomized prospectively to three groups. The dorsum of the nondominant hand was covered with a thick paste of 2.5g of EMLA(®) cream in the EMLA(®) group (group E) and left for a minimum of 30min 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). 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). The Valsalva maneuver yields similar results to the EMLA(®) in terms of pain reduction during venipuncture.