Ethyl chloride spray, a local anesthetic in arterial blood gas sampling: A randomized, controlled, double-blinded study.

AIM: Arterial blood gas sampling provides useful information on respiratory parameters and acid-base balance. However, this procedure is painful and uncomfortable for the patient. Therefore, this study aimed to examine the analgesic efficacy of ethyl chloride spray compared to a placebo during radial artery blood gas sampling. METHOD: This randomized, double-blind, placebo-controlled study was conducted at the emergency department of a tertiary hospital. A total of 202 patients were randomly divided into two groups: ethyl chloride spray (n = 101) and placebo (n = 101). The analgesic efficacy of ethyl chloride spray was compared with the placebo using the Visual Analog Scale (VAS). RESULTS: The VAS score was determined to be 4 [interquartile range (IQR): 1.0] for the ethyl chloride spray group and 5 (IQR: 1.0) for the placebo group. The analgesic efficacy of ethyl chloride spray in reducing pain was statistically significantly higher compared to the placebo (p = 0.000). CONCLUSION: Ethyl chloride spray has analgesic efficacy in arterial blood gas sampling. Therefore, the use of this spray provides an analgesic effect on patients during arterial blood gas sampling performed in the emergency department.

Ethyl chloride spray for musculoskeletal ultrasound-guided injections: An alternative to subcutaneous injection of local anesthetic solution.

Ultrasound-guided injections such as steroid injections are common procedures involving the musculoskeletal system. They are usually performed after a subcutaneous injection of local anesthetic (LA), which can be painful. In 126 consecutive patients, local anesthesia was performed using ethyl chloride spray prior to a therapeutic ultrasound-guided injection in joints, tendons, or bursae. Ninety-nine (78.5%) patients found the use of ethyl chloride spray helpful. The use of ethyl chloride spray is an effective, patient-friendly alternative to the standard injection of local aesthetic for ultrasound-guided therapeutic musculoskeletal injections with the advantage of a lower cost of $0.18 per procedure.

Effects of ethyl chloride spray on early recovery after total knee arthroplasty: A prospective study.

BACKGROUND: Ethyl chloride spray as a common cooling modality has been widely used in acute sports injuries and joint injection procedures. Several clinical studies reported that use of ethyl chloride has positive effects on swelling, pain reduction and recovery from sports injuries. The main aim of present study was to analyze whether postoperative use of ethyl chloride spray benefits results after primary total knee arthroplasty (TKA). METHODS: Between April 1, 2014 and October 21, 2015, 306 subjects undergoing primary TKA used ethyl chloride spray for improving recovery from the damage from surgery. After exclusion of 31 subjects due to adverse events including periprosthetic joint infection (PJI), deep venous thrombosis (DVT), acute myocardial infarction, finally 275 subjects' data regarding pain score, knee range of motion (ROM), knee girth, time of being able to reach 90° knee flexion and analgesic consumption were analyzed. RESULTS: Significant differences in pain score, knee ROM at each time point and knee girth at on 21st and 28th postoperatively were detected without increased incidence of adverse events. Besides, time of being able to reach 90° knee flexion and analgesic consumption in the treatment group were significantly decreased in comparison to the control group. CONCLUSION: Use of ethyl chloride spray can help patients recovery from the damage from TKA safely.

Overcoming the Challenges of Unstructured Data in Multisite, Electronic Medical Record-based Abstraction.

BACKGROUND: Unstructured data encountered during retrospective electronic medical record (EMR) abstraction has routinely been identified as challenging to reliably abstract, as these data are often recorded as free text, without limitations to format or structure. There is increased interest in reliably abstracting this type of data given its prominent role in care coordination and communication, yet limited methodological guidance exists. OBJECTIVES: As standard abstraction approaches resulted in substandard data reliability for unstructured data elements collected as part of a multisite, retrospective EMR study of hospital discharge communication quality, our goal was to develop, apply and examine the utility of a phase-based approach to reliably abstract unstructured data. This approach is examined using the specific example of discharge communication for warfarin management. RESEARCH DESIGN: We adopted a "fit-for-use" framework to guide the development and evaluation of abstraction methods using a 4-step, phase-based approach including (1) team building; (2) identification of challenges; (3) adaptation of abstraction methods; and (4) systematic data quality monitoring. MEASURES: Unstructured data elements were the focus of this study, including elements communicating steps in warfarin management (eg, warfarin initiation) and medical follow-up (eg, timeframe for follow-up). RESULTS: After implementation of the phase-based approach, interrater reliability for all unstructured data elements demonstrated κ's of ≥0.89-an average increase of +0.25 for each unstructured data element. CONCLUSIONS: As compared with standard abstraction methodologies, this phase-based approach was more time intensive, but did markedly increase abstraction reliability for unstructured data elements within multisite EMR documentation.

Therapeutic opportunities when using vapocoolants for cannulation in children.

How nurses make a difference and influence outcome has been the subject of much debate over many years and is perhaps more relevant now owing to healthcare funding being a scarce commodity. Nurses need justification and validation of what they do. Nursing therapeutics is a relatively new term that can help nurses and others to appreciate the multifariousness, complexity and value of what they do. It encapsulates the means by which a nurse delivers care that is both evidence based and beneficial to his or her patients. This article highlights how nurses can make use of common nursing interventions to ensure that the full impact of their skills is embedded in their care-using the administration of vapocoolants as the focus of the discussion. It will be illustrated that through each patient contact, a nurse can establish therapeutic principles that can positively influence health outcomes.

Topical ethyl chloride to reduce pain associated with venous catheterization: a randomized crossover trial.

OBJECTIVE: To compare pain associated with venous catheterization after administration of topical ethyl chloride vs placebo among emergency department health care providers. METHODS: We conducted a randomized, double-blind, placebo-controlled, crossover trial among a convenience sample of health care provider volunteers in a tertiary care urban emergency department. We randomly allocated subjects to initial treatment (ethyl chloride vs sterile water aerosol spray) and catheterization site (left or right antecubital fossa). After venous catheterization placement and discontinuation, subjects underwent a 5-minute washout period. All subjects then underwent venous catheterization in the contralateral antecubital fossa after administration of the alternative agent. We measured all outcomes after discontinuation of the second catheter. The primary outcome was difference in pain verbal numeric rating scale score (0-10) between the 2 agents. Secondary outcomes included preferred agent (binary) and future willingness to use agent on patients (5-point Likert scale). RESULTS: Thirty-eight health care providers were recruited; all completed the study. Median pain verbal numeric rating scale scores were 4 (interquartile range, 2-5) for placebo vs 2 (1-4) for ethyl chloride. The effect size for pain reduction with ethyl chloride compared with placebo was 2 (95% confidence interval, 0.5-2; P = .001). Most subjects (68.4%) preferred ethyl chloride to placebo. Five-point Likert scale scores measuring willingness to use preferred product on future patients were higher by 2 (95% confidence interval, 1-3) among subjects preferring ethyl chloride vs placebo. CONCLUSIONS: We found that topical ethyl chloride yields a greater reduction in pain associated with venous catheterization compared with topical placebo.

Fast and Painless Skin Tag Excision with Ethyl Chloride.

Skin tags (acrochordon) are skin colored or hyperpigmented, usually pedunculated benign skin lesions and often occur on the neck, axilla, and groin regions. It is difficult choice to excise these multiple, widespread, and pedinculated lesions with or without local anesthesia. One option is to infiltrate local anesthesia to every single skin tag, while cutting pedicle with single move is another option. However, both of these options are painful to some degree. We routinely use ethyl chloride spray anesthesia for skin tag excision with micro-scissor and micro-forceps. We received positive feedback from patients, who underwent skin tag excision before with conventional techniques. They declare that ethyl chloride procedure is more comfortable and painless.

Combination treatment of interferon ß-1b and warfarin for a patient with Baló's concentric sclerosis and antiphospholipid syndrome.

BACKGROUND: Baló's concentric sclerosis (BCS), a rare variant of multiple sclerosis (MS), as the initial presentation of antiphospholipid syndrome (APS) is unusual. The pathogenic role of antiphospholipid antibodies in the development of MS remains unknown. Anticoagulant therapy might be used in patients with MS and APS for prevention against the relapse of MS. CASE REPORT: We present a 27-year-old man diagnosed as BCS with APS. Initially, after corticosteroid therapy, he exhibited a complete recovery. During follow-up, his Baló-like lesion dissolved over time but transformed into other asymptomatic MS-like lesions. He also had persistently elevated anticardiolipin IgG levels. The patient was, therefore, on a combined therapy of interferon ß-1b and an anticoagulant agent. No new brain lesions were found on 2 occasional head magnetic resonance imaging studies at 1 year follow-up. CONCLUSIONS: To prevent further MS relapse and thrombotic complications of APS, a combined therapy of interferon ß-1b and an anticoagulant agent can be an important strategy in treating patients with both BCS and APS.

A Clinical Comparison of EMLA Cream and Ethyl Chloride Spray Application for Pain Relief of Forehead Botulinum Toxin Injection.

OBJECTIVES: This study aims to analyze the efficiency of EMLA cream and ethyl chloride spray application for pain alleviation before botulinum toxin injection. METHODS: Forty-five patients were divided into 3 treatment groups. Skin cooling with ethyl chloride spray (in group 1), topical anesthetic cream (EMLA) (in group 2), was used on the forehead area on one side previous to injection; the opposite side served as the control. In the third group (n = 15), cold was applied using ethyl chloride spray to one side, and to the other side topical anesthetic cream (EMLA) was applied. A visual analog scale was used for pain intensity. RESULTS: In the first group, the average pain score was 3.20 ± 1.20 on the side where ethyl chloride spray was applied and 7.26 ± 1.94 on the control side (P < 0.05). It was 4.20 ± 1.37 on the side receiving EMLA and 7.66 ± 1.54 (P < 0.05) on the control side in the second group. In the third group, the average score was 6.80 ± 1.37 for the EMLA side and 2.93 ± 1.03 for the ethyl chloride sprayed side (P < 0.05). CONCLUSIONS: Skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.

[Ethyl chloride]. / Cloruro de etilo.

The control of symptoms in general and pain in particular, remains a current topic in scientific conferences and meetings, and discussed the recommendations of the Scientific Societies. Do not suffer unnecessary pain because the treatment is a right of every patient and facilitating action to control it, by nurses, is an expression of respect for that right. A common procedure nursing care consists of venous and arterial puncture for blood samples or to place catheters for different purposes, these procedures are painful for the patient and sometimes unpleasant by the need to perform them repeatedly. There are different relaxation techniques that can help to reduce this effect in the body but also have pharmacological interventions to help decrease the pain associated with vascular punctures. One of them, easy to use, quick to act and no side effects is the use of topical anesthesia by cold ethyl chloride.

Ethyl chloride as an antipruritic agent: a double-blind placebo-controlled prospective study.

BACKGROUND: Ethyl chloride (EC) is usually used as a topical anesthetic spray agent. However, its antipruritic effects have never been studied, to the best of our knowledge. METHODS: A double-blind placebo-controlled prospective study. Overall, 51 healthy volunteers underwent a histamine skin prick test on both arms in order to trigger local pruritus. Thereafter, the affected areas were treated with an EC spray on one arm and a saline spray (placebo) on the other. Subjects as well as researchers were blind to which sprays were used. Subjects reported improvement in pruritus following EC/placebo and rated the intensity of pruritus by using a validated questionnaire and a visual analog scale. The flare and wheal reactions were measured in both arms before and following treatment with EC/placebo. RESULTS: Significant improvement in pruritus was reported more frequently following treatment with EC compared with placebo (84 vs. 16%; p < 0.0001). Significant reduction in pruritus intensity was reported immediately and 15 min following treatment with EC compared with placebo (p < 0.05). There was no significant difference between EC and placebo in terms of the flare and wheal reactions. CONCLUSIONS: EC is an effective antipruritic agent, and it does not change the wheal and flare reactions, making it ideal for treating pruritus secondary to allergy skin tests without masking their results.

Cloruro de etilo. Anestesia local mediante frío / Ethyl chloride. Local anesthesia by cold

El control de los síntomas en general y del dolor en particular sigue siendo un tema actual en los congresos y reuniones científicas, y objeto de debate en las recomendaciones de las sociedades científicas [1]. No sufrir un dolor innecesario debido al tratamiento es un derecho de todo enfermo y facilitar las medidas que lo controlen, por parte de las enfermeras, supone una expresión de respeto hacia ese derecho. Un procedimiento habitual de los cuidados de enfermería consiste en la punción venosa y arterial para realizar extracciones sanguíneas o colocar catéteres con distintos fines; estos procedimientos resultan dolorosos para el paciente y muchas veces desagradables por la necesidad de realizarlos de forma repetida. Existen diferentes técnicas de relajación que pueden contribuir a la disminución de este efecto en el paciente pero también disponemos de intervenciones farmacológicas que contribuyen a disminuir el dolor asociado a las punciones vasculares [2]. Una de ellas, fácil de utilizar, rápida de actuar y sin efectos secundarios consiste en la utilización de anestesia tópica mediante frío con cloruro de etilo(AU)

The control of symptoms in general and pain in particular, remains a current topic in scientific conferences and meetings, and discussed the recommendations of the Scientific Societies [1]. Do not suffer unnecessary pain because the treatment is a right of every patient and facilitating action to control it, by nurses, is an expression of respect for that right. A common procedure nursing care consists of venous and arterial puncture for blood samples or to place catheters for different purposes, these procedures are painful for the patient and sometimes unpleasant by the need to perform them repeatedly.There are different relaxation techniques that can help to reduce this effect in the body but also have pharmacological interventions to help decrease the pain associated with vascular punctures [2]. One of them, easy to use, quick to act and no side effects is the use of topical anesthesia by cold ethyl chloride(AU)

Uso de cloruro de etilo tópico para disminuir el dolor asociado a la punción venosa / Use of ethyl chloride topical to reduce pain associated with intravenous cannulation

El cloruro de etilo es un anestésico tópico de acción rápida que produce analgesia por enfriamiento local del área en que se aplica. Objetivo: Evaluar la eficacia del cloruro de etilo pulverizado para reducir el dolor de las punciones venosas en niños. Pacientes y Método: Realizamos un estudio prospectivo, de 80 pacientes pediátricos vistos en el servicio de urgencias observación de nuestro hospital, que precisaron punción en antebrazo. Los pacientes se distribuyeron en dos grupos: grupo A: 40 pacientes a los que se aplicó cloruro de etilo previo a la punción venosa; grupo B: 40 pacientes a los que no se aplicó cloruro de etilo. Las variables analizadas fueron edad, sexo, reflejo de retirada, evaluación del dolor experimentado en la punción y rendimiento de la extracción de sangre venosa. Se realizó estadística básica para las variables cuantitativas y comparación de los grupos mediante chi-cuadrado o t de student. Se consideró significativa una p<0,05). No se encontraron diferencias estadísticamente significativas en cuanto a la variable “refluir la sangre”. Conclusiones: La aplicación de cloruro de etilo pulverizado durante 5-10 segundos en el antebrazo, previa a la realización de la punción venosa, disminuye la sensación dolorosa y sin efectos secundarios significativos. El reflejo de retirada del brazo al pinchar es menos frecuente tras la aplicación de cloruro de etilo. El enfriamiento local que produce no interfiere con el rendimiento de extracción de sangre de manera significativa (AU)

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A randomized controlled trial of vapocoolant for pediatric immunization distress relief.

OBJECTIVES: The purpose of this study was to evaluate the effectiveness of vapocoolant for preschoolers' immunization injection pain relief. METHODS: Fifty-seven 4 to 6-year-old children were randomized into vapocoolant alone or typical care conditions. Pain was measured at the baseline and at injection via self-report, caregiver report, nurse report, and by an observational scale. RESULTS: Self-report of pain suggested that children in the vapocoolant alone condition demonstrated stronger increases in pain from baseline to injection than children in the typical care condition. All other measures showed significant increases in pain from baseline to injection, but no other measures indicated treatment effects. DISCUSSION: This study revealed that vapocoolant is not an effective pain management intervention for children's intramuscular injections.

Anaesthesia for arterial puncture in the emergency department: a randomized trial of subcutaneous lidocaine, ethyl chloride or nothing.

OBJECTIVE: To determine whether the use of ethyl chloride and subcutaneous lidocaine are associated with a reduction in pain during arterial blood sampling compared with using no local anaesthesia. METHODS: Patients over the age of 16 years and who required arterial blood sampling as part of their on-going emergency department management were randomly allocated to one of three groups. Group A received routine skin preparation before arterial puncture (AP); group B received 0.5 ml of 2% lidocaine 2 min before AP; and group C received ethyl chloride immediately before AP. Pain was measured using 100-mm visual analogue scale. SETTING: Two urban emergency departments. RESULTS: Fifty-four patients were recruited. Those receiving lidocaine before AP had lower pain scores [10.2 mm, 95% confidence interval (CI): 4.8-16.3 mm] compared with the use of ethyl chloride (23.9 mm, 95% CI: 12.4-35.5 mm) and nothing (23.4 mm, 95% CI: 11.7-35.0 mm). Lidocaine was more painful to administer (22.0 mm, 95% CI: 10.9-33.7 mm) compared with ethyl chloride (12.9 mm, 95% CI: 5.5-20.3 mm). CONCLUSION: Ethyl chloride is not an effective local anaesthetic agent for AP. When the pain of local anaesthetic administration is taken into account the benefit of subcutaneous lidocaine for single AP is limited.

Lignocaine is a better analgesic than either ethyl chloride or nitrous oxide for peripheral intravenous cannulation.

BACKGROUND: Peripheral intravenous (i.v.) cannulation is a painful, frequently performed ED procedure. It is common practice in other medical settings to offer analgesia prior to cannulation. OBJECTIVE: The present trial aims to reproduce in the ED studies that found a reduction in the pain of i.v. cannulation after intradermal lignocaine, ethyl chloride topical spray and entonox (50:50 oxygen : nitrous oxide). It also intends to determine which is analgesic most effective and explore the role of entonox for cannulation analgesia. METHODS: Three hundred subjects were randomized into four groups: i.v. cannula inserted with (i) no anaesthesia; (ii) entonox; (iii) ethyl chloride; and (iv) 0.1 mL intradermal 1% lignocaine. Pain was recorded on 100 mm visual analogue scales (VAS) after lignocaine injection or ethyl chloride spray and following i.v. cannulation. A clinically significant reduction in VAS pain score was determined to be 13 mm. RESULTS: Patients cannulated without analgesia reported the most pain. Those cannulated after lignocaine had the least pain (median VAS 20 mm, 95% CI 15-25, vs 1 mm 95% CI 0-6, P < or = 0.001). Ethyl chloride (VAS 11 mm, 95% CI 7-15, P = 0.003) and entonox (VAS 13 mm, 95% CI 8-18, P = 0.047) reduced i.v. cannulation pain but did not reach clinical significance. Neither pain from presenting symptoms (P = 0.3), nor size of cannula (P = 0.8) affected pain scores. VAS scores were independent of sex and age (P = 0.1). Cannulation success was not affected by either the choice of analgesia or cannulation site. CONCLUSIONS: The present trial confirms the findings of Harris and colleagues that lignocaine reduces the pain of cannulation in the ED. Lignocaine reduced the pain of i.v. cannulation more effectively than entonox or ethyl chloride.

Ethyl chloride as a cryoanalgesic in pediatrics for venipuncture.

INTRODUCTION: Ethyl chloride can be used as a cryoanalgesic, but with the availability of alternative and relatively safer topical analgesics, its use has decreased. However, it still has the advantage of being quicker to apply compared with other topical analgesics, making it ideal for use in the outpatient departments. We wanted to compare the effectiveness of ethyl chloride as an analgesic during venipuncture in children. METHODS: Venipuncture was carried out using either no analgesia (NO), ethyl chloride spray (EC), or application of the topical anesthetic Ametop (TA) on children attending the phlebotomy outpatient service by experienced pediatric phlebotomists. A pain score was recorded using either the Faces scoring system or the Faces, Legs, Activity, Cry Consolability scoring system. RESULTS: A total of 55 patients were included in the study, 18 from group EC, 18 from group TA, and 19 from group NO. Thirteen patients from both groups EC and TA and 17 from group NO scored 2 or less on the pain scores. DISCUSSION: The use of ethyl chloride was as effective as topical anesthetics in preventing distress to children in venipuncture. However, in the appropriate situations, the use of NO could also be comfortable to the child if venipuncture was done by specialist pediatric phlebotomists.

Reducción del dolor de las punciones vasculares. Una intervención enfermera / Reducing pain in vascular punctures. A nursing intervention

La satisfacción de los pacientes relacionada con los cuidados enfermeros querecibe es uno de los mejores indicadores de calidad de satisfacción total. Lainserción de un catéter intravenoso para la administración de medicaciones ola realización de pruebas diagnósticas mediante acceso vascular son procedimientostemidos por muchos adultos y por casi todos los niños. Realizando unaadecuada anestesia local previa a la inserción del catéter se consigue evitar lasensación dolorosa que experimentan los pacientes.En este artículo se revisan tres de las intervenciones farmacológicas más comunesque pueden utilizar las enfermeras para reducir el dolor asociado a lasvenopunciones o las punciones arteriales: aplicación de cloruro de etilo, inyecciónde lidocaína intradérmica y aplicación de crema EMLA.Se describen los procedimientos para su utilización eficaz y se comparan lasventajas e inconvenientes de cada uno de ellos

Patient satisfaction in what refers to nursing care is one of the best quality indicationsof total satisfaction. Inserting an endovenous catheter for the administrationof medication or to perform diagnostic tests via a vascular accessis a much-feared procedure by many adults and virtually by all children. Applyingadequate anaesthesia prior to the insertion of the catheter avoids thepain experienced by the patients.This article reviews the three most common pharmacological interventionsused by nurses to reduce the pain associated to vein punctures or arterialpunctures: application of ethyl chloride, intradermal injection of lidocaineand application of EMLA cream.Procedures are described for an effective application and a comparison of the advantages and drawbacks of each of them presented (AU)

Ethyl vinyl chloride vapocoolant spray fails to decrease pain associated with intravenous cannulation in children.

The purpose of the study was to determine the effect of ethyl vinyl chloride vapocoolant spray on pain reported by children undergoing intravenous cannulation. A randomized, double-blinded, placebo-controlled trial was conducted on eligible children between the ages of 9 and 18 years seen in a pediatric emergency department and requiring intravenous cannulation. Informed consent was obtained, and children were randomized to receive ethyl vinyl chloride spray, isopropyl alcohol spray, or no spray (control group). Patient demographics and information pertaining to each intravenous cannulation were recorded. Children indicated the degree of pain associated with intravenous cannulation on a 100-mm visual analog scale (VAS) compared to a baseline pain score of "zero." Statistical analysis was performed by using Stata version 7. One hundred twenty-seven subjects were enrolled: 37 received ethyl vinyl chloride vapocoolant spray, 48 received isopropyl alcohol spray (placebo), and 42 received no pretreatment. Mean VAS scores for pain experienced during cannulation were 34, 33, and 31 mL for each group, respectively. Ethyl vinyl chloride vapocoolant spray failed to measurably reduce pain associated with intravenous cannulation when compared to those pretreated with isopropyl alcohol spray or receiving no intervention.