Among pediatric patients, phlebotomy is an important source of self-reported pain in the pediatric emergency department (ED). Unmanaged needle pain has been linked to immediate distress, increased anxiety, and greater pain with future procedures, as well as long-term consequences such as needle phobia, heightened pain sensitivity, and avoidance of necessary healthcare in adulthood [[1], [2], [3], [4], [5]]. Various methods have been proposed for the management of acute pain associated with these medical procedures. Pharmacological methods include EMLA (a eutectic mixture of local anesthetics), lidocaine and ethyl chloride (vapocoolant). Behavioral methods such as information provision, distraction, sensory focusing, and cognitive behavioral therapy (CBT) have also been utilized [6].

Optimization of pain control during phlebotomy in the pediatric ED is essential to avoid the adverse effects of needle insertion. Quick-acting, easy-to-apply interventions that are acceptable to patients and providers are preferred in this fast-paced setting, favoring methods over those requiring longer onset times, such as EMLA and cognitive behavioral therapy (CBT). Despite multiple available strategies, there is no clear consensus on the best intervention for procedural pain in this environment, highlighting the need for comparative effectiveness studies. Vapocoolants, volatile refrigerated liquids such as ethyl chloride, are a frequent choice in many pediatric EDs prior to phlebotomy. Despite this, research has offered conflicting results as to their efficacy. One systematic review of vapocoolants in both children and adults and concluded that vapocoolants may not be effective in children when compared to control or no treatment [7]. Another study hypothesized that the sensation of cold on the skin can be perceived as pain by children [8].

Recently companies have developed handheld devices based on Melzack and Wall’s gate control theory which asserts that activation of non-nociceptive fibers can interfere with signals from pain fibers thereby inhibiting pain. This theory helps to explain why rubbing or massaging a painful area of skin can lessen the pain. Melzack and Wall proposed two processes by which the gating mechanism works. The first suggests that efferent signals from the brain interfere with the afferent pain signal from the tissue damage. The second mechanism suggests that ascending signals from peripheral nerves serve as competing sensory information. According to the gate control theory, the pain perception will be diminished via interference by the other physical stimulation [9]. Several devices have been developed to alleviate pain by use of the gate control theory; one is the Buzzy. Buzzy is a vibrating palm-sized device with removable ice wings developed by MMJ Labs Atlanta, GA [10]. The Buzzy is a bee or ladybug shaped vibration unit that has a detachable ice pack in the shape of wings. The device is placed proximal to the procedure site to interfere with pain perception. Several prior studies have shown Buzzy effective in decreasing pain during needle related procedures, however these results are limited and focus mainly on controlled outpatient settings [11]. Given the distinct challenges of the pediatric emergency department, including higher patient acuity, variable procedural urgency, and a fast-paced environment, more research is needed to assess these findings specifically in the pediatric ED. This will help develop effective pain management protocols and guide optimal strategies tailored to the ED.

The purpose of this study was to compare Buzzy and vapocoolant in providing pain relief for IV insertion in a pediatric emergency department. We hypothesized Buzzy would provide greater pain relief compared to vapocoolant and no intervention based on patient self-report and parent report of their child’s pain.