Efficacy of Topical Lidocaine to Decrease Discomfort With Intranasal Midazolam Administration

This was a double-blinded, randomized, placebo-controlled trial performed in an urban, academic pediatric emergency department with an annual census of 67,000 patients. Children 6-12 years old for whom IN midazolam was ordered were eligible for enrollment. Patients were randomly assigned an identical intranasal medication (4% Lidocaine or 0.9% saline). Patients were administered the study drug followed by IN midazolam. Patients then assigned a pain score for midazolam administration using the Wong-Baker FACES Pain Rating scale. The primary endpoint of pain score was analyzed with a two-tailed Mann-Whitney U test, with P < 0.05 considered statistically significant.

Inclusion criteria

• Ages 6-12
• Previously healthy
• Attending physician concludes that the patient would benefit from administration of an anxiolysis medication prior to a minor procedure

Exclusion criteria

• Moderate to severe asthma or other chronic lung disease
• Co-morbid conditions including cerebral palsy, developmental delay, or other chronic illness deemed by the Attending physician to be unsafe to receive anxiolysis with Versed.
• Any child presenting with a life-threatening condition.