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Abstract
A short cut review was carried out to establish whether there is any evidence to show that stripping the stratum corneum with adhesive tape reduces time to analgesia after application of EMLA in children undergoing venepuncture. Altogether 43 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated. A clinical bottom line is stated
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Report by Simon Carley,Specialist Registrar Checked by Kerstin Hogg, Clinical Research Fellow
Clinical scenario
A 2 year old child presents to the emergency department with a limp. The child is mildly feverish and has some limitation of movement. You decide to take blood as part of your diagnostic strategy to exclude septic arthritis. The parents are keen to get on with the tests and are disappointed that the EMLA cream you intend to use takes so long to work. The paediatric emergency nurse suggests using tape to “clean” the skin before application to get the EMLA to work faster. You have no idea what she is talking about but wonder whether there is any evidence to show that she is right.
Three part question
In [children undergoing venepuncture after EMLA cream] does [stripping the stratum corneum with adhesive tape] reduce [time of onset, pain and distress of the procedure]?
Search strategy
Medline 1966–04/02 using the OVID interface. [EMLA.mp OR eutectic.mp OR ({exp anesthesia, local OR exp anesthetics, local OR exp Lidocaine OR local anaesthetic$.mp OR local anesthetic$.mp} AND {exp administration, topical OR topical.mp})] AND [exp adhesives OR exp bandages OR TAPE.mp] LIMIT to human AND English.
Search outcome
Altogether 47 papers were found of which one was relevant to the three part question. This paper is shown in table 7.
Comment(s)
The single study found shows a small benefit to tape stripping, but only involves adult patients undergoing venepuncture. It is debatable whether the small differences in VAS seen are clinically important (normally at least a change of 10 mm would be considered significant). In our practice EMLA is almost exclusively used in children. There is an amount of pain that is attributable to the tape stripping procedure, though this is a low value. However, applying the tape and stripping it 20 times is likely to be distressing for many children. This adult study does not investigate the probable difficulties in applying this technique in children. It is our perception that they would find the tape stripping distressing. For this reason we do not feel that it is possible to extrapolate the results of this study to children.
CLINICAL BOTTOM LINE
Tape stripping the stratum corneum increases the effectiveness of EMLA in adults by a small degree. Its effectiveness in children is unknown.
Report by Simon Carley,Specialist Registrar Checked by Kerstin Hogg, Clinical Research Fellow