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A Cooling Spray (Fluori-Methane) Reduces Immunization Injection Pain

Children continue to experience the pain and distress of immunization injections despite advances in the management of pain. Parents also experience distress related to untreated immunization pain. Furthermore, lack of pain control for injections is a barrier to immunization. Many health care providers withhold scheduled vaccines out of concern for the excessive pain of simultaneous immunizations (Szilagyi, Rodewald, and Humiston, 1994). There is also the possibility that parental resistance to multiple immunizations contributes to underimmunization.

A recent study by Reis and Holubkov (1997) compared two pain management methods in reducing immunization injection pain and distress in children 4-6 years of age. In this study, 62 children were randomly assigned to one of three groups: 1) EMLA (eutectic mixture of local anesthetics) cream + distraction, 2) vapocoolant spray (Fluori-Methane) + distraction, or 3) distraction alone (control). For distraction, all children blew on a pinwheel during the injections. Several pain and distress scales were completed by the child, parent, nurse administering the immunization, and an investigator who viewed videotapes without knowing to which treatment group the children were assigned. The vaccine used was the DTaP. It was given into the deltoid muscle, using a 26 gauge, 1/2 inch needle. EMLA cream was applied 60 minutes before the injection, according to the manufacturer's instructions. Fluori-Methane spray was applied with a spray-saturated cotton ball for 15 seconds before the injection. (Although this vapocoolant may be sprayed directly on the injection site, the cotton ball technique was chosen because some patients experienced the coolness of the direct spray as a noxious stimulus.)

The study found that all pain measures and cry duration were similar for EMLA and the vapocoolant, and that both interventions were significantly better than distraction alone. It is interesting to note that parents said they would be willing to pay for this pain treatment in the future. The vapocoolant spray (about $0.50 per use) is much less expensive than EMLA cream (about $15.00 per 2-dose tube) and significantly faster acting. Both are prescription drugs.

Nurses are in a unique position to encourage methods to reduce immunization injection pain in children. Vapocoolant spray is an effective, convenient, and inexpensive pain control method. In addition to its value for pain control, Fluori-Methane spray may help overcome the barrier of resistance to multiple injections that leads to underimmunization in children.

References

• Reis EC and Holubkov R: Vapocoolant spray is equally effective as EMLA cream in reducing immunization pain in school-aged children, Pediatrics 100(6): e5-14, 1997.
• Szilagyi PG: Immunization practices of pediatricians and family physicians in the United States, Pediatrics 94: 517-523, 1994.
• See Chapters 12 and 26 in Nursing Care of Infants and Children, 6th edition.
• See Chapters 10 and 21 in Essentials of Pediatric Nursing, 6th edition

Related Research

Gedaly-Duff V, Burns C: Reducing children's pain-distress associated with injections: a pilot study, J Am Acad Nurse Pract 4(3):95-100, 1992.

(Found that ice placed on the skin for 30 seconds before the injection did not decrease child's pain rating.)

Abbott K, Fowler-Kerry S: The use of a topical refrigerant anesthetic to reduce injection pain in children, J Pain Symptom Manage 10(8):584-590, 1995.

(Found that Fluro-ethyl sprayed on a cotton ball that was placed on the skin for 10 seconds before the injection decreased child's pain rating.)

Information on Fluori-Methane and ethyl chloride is available from Gebauer Co., 9410 Saint Catherine Ave., Cleveland, OH 44104; 800-321-9348; Website: www.gebauerco.com.

March 15, 2002

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