This randomized clinical trial involves double blind allocation of either (1) Jet administration of buffered 1% lidocaine or (2) Jet normal saline (placebo) prior to needle insertion in the PED. The product will be prepackaged on a weekly basis at an off site pharmacy into the jet injector system and all devices will be labeled as "study drug" with an assigned number. We estimate 30 patients being enrolled in each one-month period and the pharmacy will allocate 10 devices of study medication and 10 devices of normal saline. Our estimated sample size is 84 patients per group. The study duration will continue until the sample size is achieved. An interim analysis of data will be performed after 25% or 21 patients are obtained in each group.