A comparison between valsalva maneuver and eutectic mixture of local anaesthetic to relieve venepuncture pain

Venepuncture is a painful but necessary prerequisite for safe administration of anaesthesia. Various pharmacological and non pharmacological methods have been attempted to decrease venepuncture pain. EMLA (eutectic mixture of 2.5% lidocaine and 2.5% prilocaine) cream facilitates the local absorption of both constituent drugs without organic solvents, resulting in high concentrations of lidocaine/prilocaine in the skin. Valsalva maneuver reduces the severity of pain associated with venepuncture, via stimulation of the vagus nerve. We conducted an observational study to evaluate the efficacy of Valsalva maneuver and EMLA cream in decreasing venepuncture pain. After obtaining approval from the Indian Ethics Committee, 129 American society of anesthesiology Class 1 & 2 patients who were posted for various surgeries, aged 18-60 years were chosen after obtaining consent. They were randomly allocated into two groups using computerized tables (Group E - 65, Group V - 64), with application of EMLA cream (Group E) and valsalva maneuver (Group V) being performed prior to venepuncture. Post venepuncture, VAS, pain score (to assess subjective and objective pain) and changes in hemodynamic parameters were assessed. Data was analysed using student unpaired 't' test, student paired t test and X2 test. Average Pain score and VAS score for Group E was 1, 0.94 and in Group V was 2 and 2.24 respectively (p <0.0001). Average change in HR and MAP was 3 bpm and MBP 1 mm Hg in Group E, and 6 bpm and MBP 3 mm Hg in Group V, comparing prior and post venepuncture parameters . Average increase in HR and MBP was seen to be significantly more in Group V than in Group E.(p <0.0001). Pain on venepuncture after EMLA cream application was significantly lesser than pain on venepuncture after valsalva maneuver.