Xylofuns: Xylocaine to Freeze during Unpleasant Nasopharyngeal Swabs in Children - a Randomized Controlled Trial

ABSTRACT

BACKGROUND: Nasopharyngeal (NP) swabs have been recommended to detect SARS-CoV-2 since the beginning of the COVID-19 pandemic, but are reported to be at least moderately painful. OBJECTIVE(S) To evaluate the efficacy of intranasal vaporized lidocaine compared to a sham treatment in reducing pain in children undergoing a NP swab in the Emergency Department (ED). DESIGN/METHODS: A randomized double-blinded clinical trial was conducted in a pediatric ED. Both participants and the researcher evaluating the primary outcome were blinded. Children 6 to 17 years old requiring a NP swab were eligible. Participants were randomly allocated to receive intranasal lidocaine or a sham treatment prior to their NP swab. The primary outcome measure was pain during the swab as assessed by the visual analog scale. Secondary outcome measures were pain using the verbal numeric rating scale, fear using the children fear scale, and side effects of the intervention. RESULT(S) Eighty-eight participants were enrolled 45 to the lidocaine group and 43 to the control group. The mean visual analog scale scores for pain were 46 mm in the lidocaine group and 53 mm in the control group (mean difference 7 mm;95%CI -5 to 19 mm). The numeric rating scale and children fear scale were not statistically different between groups. No serious adverse events were observed. Fear prior to the test and younger age were associated with higher pain scores. CONCLUSION(S) Intranasal lidocaine administered prior to NP swabs in the ED did not lower pain scores for school-aged children and youth.