Drugs and Device Comparison Chart

Item / Product Uses: Procedures, Age Action and Application Time Caution, contraindications Supplier, Cost, Waste and information L-M-X-4 Youngest age studies- full-term Liposomal 4% Occlusive dressing needed in Eloquest Healthcare newborns. available over the counter. small children to prevent http://www.eloquesthe Topical ingestion. althcare.com/products/ contains 4% Lidocaine Use for temporary relief of Analgesia in 20-30 minutes. lmx4.aspx pain associated with minor Blanching may be less than burns, cuts and bits. Not used on children under 2 seen with EMLA. One 5gm tube unless order by MD/provider. $9.90(single use) Research studies on No risk of One 15gm tube $25.03 venipuncture, IV access, Does not need occlusive methemoglobinemia. newborn circumcision, dressing. One 30gm tube $46.30 meatotomy. No reports on its use with Reported faster onset than immunizations, but could be Tegaderm or Has been used for port access. EMLA. considered for use with painful transparent injections and immunizations dressing/wrap is used. Dose for infants/young Dosage: 2.5 GM for venipuncture e.g. Gardasil, Neupogen. children based on weight. and IV access.

EMLA Used in all ages. Lidocaine 2.5% and Blanching of skin and 5Gm tube + 12 2.5% constriction of veins has been Tegaderm $44.57 Literature reports use with IV reported but studies indicate access, bone marrow Requires occlusive dressing. similar success rates with or 30gm tube $53.90 aspiration, port access and without the cream. hemodialysis start. Reaches dermal analgesia in 1 EMLA description and hr., maximum effect in 2-3 hrs. Limit doses/dosages in infants action can be found at lasts 1.5 hours after removal. and neonates: Prilocaine could http://www.drugs.com trigger methemoglobin /pro/emla.html Careful observation of young Requires a dollop size amount formation. children to prevent ingestion. for maximum efficacy. Patients treated with class III Dosing is age and weight-based. anti-arrhythmic drugs should be under close surveillance and ECG monitoring 7/19/11 1 of 5

Drugs and Device Comparison Chart

Item / Product Uses: Procedures, Age Action and Application Time Caution, contraindications Supplier, Cost, Waste and information considered, because cardiac effects may be additive.

J-tip – a needleless IV cannulation, LP in infants The drug is delivered SQ in a Possible injury/scarring at J-Tip www.jtip.com device and insulin injections. fraction of a second by injection site, pain, local compressed carbon dioxide. bleeding. The J-tip syringe is disposable (contains a There is a load popping sound, 10% technical failure rate. small gas cartridge) followed by a hiss that can be Syringe can be filled frightening to some children. Patient testimonials indicate with the medication by high acceptance and a clinician or filled by Analgesia starts within 1-3 satisfaction with product. pharmacy. seconds with effect in minutes. Duration 1-2 hr. Not recommended on patients Estimated cost of the J- who are receiving Tip is $1.50-4.00 (does Maximum volume that can be chemotherapeutic agents, not include the cost of injected is 0.5 ml. blood thinners, patients with medication and filling. blood disorders, or preterm infants or neonates.

Avoiding injecting over a vein and assure that the J-Tip is placed against the skin at a 90 degree angle.

Synera IV and lab draws One patch = 70 mg Lidocaine = Transient mild erythemia Synera (Lidocaine/) 3 yrs. and older-(adults) 70 mg Tetracaine (71%), as well as blanching http://www.synera.com Integrated heating and edema. component generates a Effect in 20- 30 minutes ZARS Pharma mild warming on Not recommended in patients Cost per patch: $15.36 e administration. with broken/inflamed skin or compromised skin barrier.

Contraindicated in patients with known hypersensitivity 7/19/11 2 of 5

Drugs and Device Comparison Chart

Item / Product Uses: Procedures, Age Action and Application Time Caution, contraindications Supplier, Cost, Waste and information to para-aminobenzoic acid (PABA).

Caution in patients receiving class I anti-arrhythmics and/or other local , because the systemic toxic effects may be additive and potentially synergistic with Lidocaine and Tetracaine.

Vapocoolant

Buzzy® is a needle- Immunizations, IV starts and Gate Control: stimulation of No cold packs on patients with Available for order on pain control device that blood draws, IM, SQ and touch and temperature nerves Raynaud’s Disease or Sickle the website. incorporates vibration intradermal injections, finger closes the fast pain gate via Cell. and cold. Buzzy® uses and heel sticks. presynaptic inhibition in the Device, cold pack and natural pain relief by dorsal horn. Do not place where skin is distraction cards = confusing the body's Children > 4 y.o. have broken or there is $40.00 own nerves and responded the best. Can be Procedure compromised skin integrity. Buzzy4shots.com distracting attention used in infants and toddlers. No cold pack 6 weeks-2 yrs. away from the poke, Distraction cards/techniques for Clean device between patients. Velcro straps can break thereby dulling or all ages. and ice packs may leak. eliminating sharp pain. Place proximal to site or on the Batteries need to be inj. site for 15 seconds. If placed replaced. over inj. site, move proximal before inj. for 15 sec and keep in place during procedure.

Intradermal injection IV starts, lab draws and other ½ in 25- 30 gauge needle 1% Maximum dose of Lidocaine ? Pharmacy mix of Buffered Lidocaine procedures which require buffered Lidocaine (0.1 ml or 3mg/kg $0.28/20ml vial of 7/19/11 3 of 5

Drugs and Device Comparison Chart

Item / Product Uses: Procedures, Age Action and Application Time Caution, contraindications Supplier, Cost, Waste and information needlestick insertion ( LP, less) Lidocaine 1% + bone marrow aspiration) $1.41/50ml Sodium Rapid onset bicarbonate 8.4% Requires 2 sticks- one for the Duration1 hour medication and one for the procedure

Pain from SQ Lidocaine is reported as being less than the IV start

Intradermal Injection IV starts and lab draws. ½ in. 25-30 gauge needle. Inexpensive: cost of of Normal Saline syringe and normal Inject 0.2 to 0.4 ml or saline saline. (Benzyl is a preservative in Normal saline and has anesthetic properties.

It has been shown to be as effective as Lidocaine) (not bacteriostatic saline)

Make a wheal, insert needle through wheal.

Numby 900 Needle sticks, IV starts, PICC Administers Do not place on body parts 30ml multiple dose vial IOMED iontophoretic line insertions, lumbar electronically utilizing an that are supplied by end of iontocaine +25 drug dose controller + punctures and biopsies. application pad with Lidocaine arteries e.g. toes, fingers. delivery kits (two sizes Iontocaine 2% and epinephrine 1:100,000 small and large). topical solutions. Some children have intolerable tingling, itching, burning and May not be available in Time to anesthetic depends discomfort with the electronic US. upon the current used on the current. –need reduction in machine. Range of time is 10-20 current. 7/19/11 4 of 5

Drugs and Device Comparison Chart

Item / Product Uses: Procedures, Age Action and Application Time Caution, contraindications Supplier, Cost, Waste and information minutes. Last for 1 hr. after placement Patients under 5 yrs. should have an adult act as ground.

Children with pacemakers should not use this device.

Burns may occur due to faulty electrodes.

July 2011

7/19/11 5 of 5