Evaluation of the Effectiveness of Ethyl Chloride Refrigerant Spray for the Prevention of Injection Pain in Infants and Children during Vaccination

Introduction: Minimization of the sensation of pain during vaccinations of infants and children helps to reduce their anxiety, fear and intense reactions, ensuring the cooperation of children and enhancing their trust in health professionals. Aim: To evaluate the effectiveness of ethyl chloride refrigerant spray in comparison with EMLA cream, as a mean of alleviating acute pain during immunization in infants and children. Method: The study sample consisted of 186 infants and children aged 3 months to 8 years, randomized into three groups. In the first group local anaesthetic EMLA cream (2.5% lidocaine and prilocaine 2.5%) was applied 60 minutes before vaccination, in the second group ethyl chloride refrigerant spray was applied for 10 seconds, and in the third group (control group) no method was used for relieving injection pain. The intensity of pain was assessed by the investigator using the pain scale FLACC and by the parents with the pain scale VAS. The vital signs of the children and the duration of crying were recorded. Statistical analysis of the data was performed using the Statistical Package for Social Sciences (SPSS), v. 21.0. Results: Local anaesthetic EMLA cream was applied in 64 children before vaccination, ethyl chloride refrigerant spray was applied in 61 children and in 61 children no method for relieving injection pain was used. The scores on the pain scales and the duration of crying were similar for EMLA cream and the ethyl chloride refrigerant. The average rating (M) of the FLACC scale for each type of local anaesthesia at the time of vaccination was: For EMLA cream M=2.099±2.00, for the spray M=2.19±2.38 and for the control group M=3.72±1.43. No difference in pain indicators was detected between the two methods of anaesthesia, but there was statistically significant difference between the control group and each of the methods of anaesthesia. Conclusions: The ethyl chloride refrigerant spray is equally effective with, and less expensive and faster-acting than EMLA cream. Ethyl chloride refrigerant spray could be used as a cheap, quick and effective means for the prevention of injection pain during vaccinations, resulting in improvement of the relationship between health professionals and children and parents.