***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To assess the efficacy , acceptability , and safety of a topical alkane vapocoolant in reducing pain during intravenous cannulation in adults . Design R and omised double blind placebo controlled trial . Setting Emergency department of a metropolitan teaching hospital . Participants 201 adult patients ( 54 % male ) , mean ( SD ) age 58.2 ( 19.5 ) years , who required intravenous cannulation . Interventions Less than 15 seconds before cannulation , the skin area was sprayed with either water ( control , n=98 ) or vapocoolant ( intervention , n=103 ) , from a distance of 12 cm for 2 seconds . The intervention spray was a blend of propane , butane , and pentane . Main outcome measures Pain with cannulation and discomfort with spray , measured with a 100 mm visual analogue scale . Results Groups did not differ significantly in age , sex , indication for or site of cannulation , cannula size , or who cannulated the patient ( P>0.05 ) . Median ( interquartile range ) pain scores for cannulation in the control and intervention groups were 36 ( 19 - 51 ) and 12 ( 5 - 40 ) mm , respectively ( P<0.001 ) , and 59 ( 60 % ) and 33 ( 32 % ) reported pain scores ≥30 mm ( P<0.001 ) . Scores for spray discomfort also differed significantly ( P<0.001 ) because of skewing to the right within the intervention group . The median discomfort scores , however , were 0 mm in both groups . Success rates for first cannulation attempt did not differ between groups ( P=0.39 ) . Thirty four ( 39 % ) and 62 ( 62 % ) patients said they would choose the spray they received for analgesia in the future ( P=0.002 ) . At follow-up at five days , two patients in the intervention group reported transient skin redness . Conclusions Topical alkane vapocoolant spray is effective , acceptable , and safe in reducing pain with peripheral intravenous cannulation in adults in the emergency department . Trial registration Australian Clinical Trials ACTRN12607000470493 Objectives Mechanoreceptor and noxious thermal inhibitory stimulation modulate pain conduction but have not been clinical ly tested in combination . Our objectives were to determine whether a vibrating cold device decreased  adult venipuncture pain  on a 10 cm visual analog scale more than no intervention , and compared with vapocoolant analgesia versus no intervention . Methods The design was a prospect i ve r and omized crossover clinical trial . Thirty healthy adult volunteers were r and omized to the study device or vapocoolant intervention . One nurse attempted cannulation on both intervention and control h and s with a 22 gauge intravenous catheter . Vapocoolant was applied to the cannulation site , or the device was applied 5 to 10 cm proximally throughout the intervention attempt . Visual analog scale assessed needle fear and the primary outcome of self-reported pain . Results Sixteen device and 14 vapocoolant participants were included in this study . One participant felt discomfort from device prongs before the needle stick and was excluded . Compared with no intervention , the device reduced pain significantly ( mean 9.9 mm , 95 % confidence interval 0.82 - 19 , P=0.035 , SD 16 ) whereas vapocoolant did not ( mean 7.9 mm , 95 % confidence interval −1.8 - 17.7 , P=0.1 , SD 16.9 ) . Mean pain reduction for device group participants was not significantly different from vapocoolant participants . Each 20 mm of prior anxiety increased the likelihood of intervention pain relief ( odds ratio 2 , P=0.043 ) . One venipuncture failure occurred in the vapocoolant intervention . Discussion The combination of cold and vibration gave significant venipuncture pain relief without affecting cannulation success . Interventions were more helpful for those with greater preprocedural fear . Larger sample sizes and a prongless device could better compare equivalence or superiority to existing pain relief modalities STUDY OBJECTIVE The J-Tip ( National Medical Products Inc , Irvine , CA ) uses air instead of a needle to push lidocaine into the skin . To our knowledge , no studies have investigated its use for venipuncture in young children . We determine whether the J-Tip decreased venipuncture pain in young children compared with vapocoolant spray . METHODS Children aged 1 to 6 years were r and omized into 3 groups : intervention ( J-Tip ) , control ( vapocoolant spray ) , and sham ( vapocoolant spray and pop of an empty J-Tip ) . The procedure was videotaped and scored with the Face , Legs , Activity , Cry and Consolability ( FLACC ) tool at 3 points ; baseline , before approach ; device , at J-Tip deployment ; and at venipuncture . The FLACC tool was scored 0 ( none ) to 10 ( severe ) . Comparisons of pain scores over time were made with the generalized estimating equation . Venipuncture success and adverse effects were assessed and compared with χ(2 ) . RESULTS Two hundred five children enrolled : intervention 96 , control 53 , and sham 56 . There were no between-group differences in baseline characteristics . There was no mean change in pain scores from device to venipuncture in the intervention group ( 0.26 ; 95 % confidence interval [ CI ] -0.31 to 0.82 ) , but there was an increase in pain in the control ( 2.82 ; 95 % CI 1.91 to 3.74 ) and sham ( 1.68 ; 95 % CI 0.83 to 2.52 ) groups . This change was greater for the control and sham compared to the intervention group . There was no difference in venipuncture success between groups . No severe adverse events occurred . Minor adverse events were the same between groups . CONCLUSION Use of the J-Tip for children aged 1 to 6 years reduced venipuncture pain compared with vapocoolant spray or sham treatment Objective : Although intravenous ( IV ) line placement is a common procedure in the emergency department ( ED ) , it is an uncomfortable experience for many patients . Topical analgesic agents are rarely used because they have long onsets of action and thereby cause unacceptable treatment delays . Cryoanaesthesia , the use of cooling agents to reduce pain , has been recognised for many years as a potential pain management strategy . The purpose of this study was to determine whether an instantaneous topical skin coolant spray reduces patient ’s pain during IV cannulation and represents a feasible alternative for cutaneous analgesia in the ED setting . Methods : We conducted an unblinded , r and omised , controlled study , in a convenience sample of ED patients . Utilising a r and om number generator to assign patients to the control or study group , patients over the age of 18 years who required IV cannulation as part of their evaluation were enrolled at two tertiary care hospitals . In both groups , IV lines were placed in accordance with accepted clinical st and ards of practice , with the single addition of the coolant spray delivered to the IV site before needle insertion in the study group . All study participants answered question naires before and after IV placement and rated pain during procedure on a 100 mm visual analogue scale . Results : Of the 92 patients enrolled in the study , 47 ( 51.1 % ) were r and omised to the study group and received the anaesthetic spray , and 45 ( 48.9 % ) were r and omised to the control group and had their IV placed in a st and ard method . 66 patients were female ( 71.8 % ) and 26 ( 28.2 % ) were males . The mean pain score in the study group was 27 mm ( 95 % confidence interval ( CI ) 19.9 to 34.1 mm ) and 28 mm ( 95 % CI 20.4 to 35.6 m ) in the control group ( p = 0.934 ) . Subgroup analysis of female and male patients did not show significance . Conclusions : Our study failed to detect a difference in pain perception result ing from the pre-procedural application of a skin coolant associated with IV placement in the ED setting 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 Background : Established noninvasive pharmacologic means of alleviating pain and anxiety in children undergoing intravenous cannulation are time-consuming , and thus impractical for routine use in the emergency department . Vapocoolant sprays provide transient skin anesthesia within seconds of application . We compared the effect of a new vapocoolant spray to placebo on  pain due to intravenous cannulation in children . Methods : In this double-blind r and omized controlled trial , which we conducted between June 1 and Sept. 12 , 2006 , 80 children aged 6–12 years received either vapocoolant spray or placebo before cannulation . Children rated their pain using a 100-mm colour visual analogue scale . Secondary outcomes included success rate on first attempt at cannulation and pain ratings by the children 's parents , nurses and child life specialists . Results : We found a modest but significant reduction in pain with the use of vapocoolant spray ( mean difference 19 mm , 95 % confidence interval [ CI ] 6–32 mm ; p < 0.01 ) . Cannulation on first attempt was more often successful with the use of vapocoolant spray ( 85.0 % ) than with placebo ( 62.5 % ) ( mean difference 22.5 % , 95 % CI 3.2%–39.9 % ; p = 0.03 ) . The number needed to treat to prevent 1 cannulation failure was 5 ( 95 % CI 3–32 ) . Parents ( p = 0.04 ) , nurses ( p = 0.01 ) and child life specialists ( p < 0.01 ) considered the children 's pain to be reduced with the use of vapocoolant spray . Interpretation : The vapocoolant spray in our study quickly and effectively reduced pain due to intravenous cannulation in children and improved the success rate of cannulation . It is an important option to reduce childhood procedural pain in emergency situations , especially when time precludes traditional interventions . ( http:// Clinical Trials.gov trial register no. NCT00130650 . The purpose of this study was to evaluate the effect of ethyl chloride spray on the anxiety and pain associated with placing an intravenous catheter in patients se date d with nitrous oxide . Eighty-eight patients scheduled for dental surgery with a combination of intravenous and nitrous oxide sedation were r and omly assigned to have ethyl chloride spray or a placebo , water spray , applied before cannulation of a vein . Anxiety and pain were reported using a 10.0-cm visual analog scale before nitrous oxide administration , after nitrous oxide sedation , following application of the spray , and following venous cannulation . The first 2 assessment s measured overall levels of patient anxiety and pain and confirmed that nitrous oxide sedation reduced anxiety without changing already low levels of pain . The second 2 assessment s of anxiety and pain measured the reaction toward the spray and cannulation . The application of ethyl chloride spray produced significantly more anxiety and pain than did the placebo . The results of this study demonstrate that ethyl chloride spray does not significantly reduce the anxiety and pain associated with venous cannulation in patients se date d with nitrous oxide One hundred and twenty unpremedicated patients undergoing gynaecological surgery were r and omly allocated to one of three equal treatment groups to assess the effectiveness of ethyl chloride in producing instant skin anaesthesia to prevent the pain of venepuncture from a 20 G cannula . They received either no anaesthetic , 0.2 ml one per cent lidocaine plain intradermally or a ten-second spray of ethyl chloride at the cannulation site . Ethyl chloride produced skin anaesthesia that significantly reduced the pain of venepuncture . However , it was not as effective as intradermal lidocaine . It had no effect on vein visualisation or ease of cannulation .  Ethyl chloride can be recommended as a method of producing instant skin anaesthesia . RésuméAfin d’évaluer l’anesthésie cutanée produite par le chlorure d’éthyl , nous avons r and omisé en trois groupes 
    Output:
    
Moderate- quality evidence indicates that use of a vapocoolant immediately before intravenous cannulation reduces pain during the procedure .
Use of vapocoolant does not increase the difficulty of cannulation nor cause serious adverse effects but is associated with mild discomfort during application