Pain Alleviation of Intramuscular Injection With Lidocaine Versus Distilled Water in the Diluent of   Benzathine Benzyl Penicillin among Children with Rheumatic Fever and Rheumatic Heart  Disease at MCU-FDTMF Hospital: A Prospective Randomized Controlled

Alvin  G. Mariano,; Esguerra  M. Marivic,; Carmela Therese  P. Zamora,

Pain Alleviation of Intramuscular Injection With Lidocaine Versus Distilled Water in the Diluent of Benzathine Benzyl Penicillin among Children with Rheumatic Fever and Rheumatic Heart Disease at MCU-FDTMF Hospital: A Prospective Randomized Controlled

Alvin G. Mariano | Esguerra M. Marivic | Carmela Therese P. Zamora

Abstract:

Objective: Benzathine penicillin G (BGP) injection causes local pain and discomfort which can lead to needle phobia and non-compliance among children with rheumatic fever and rheumatic heart disease. This study aims to compare the effect of addition of lidocaine in the diluent of BPG versus distilled water in pain alleviation of intramuscular injection. Methods: This is a prospective, randomized, double blind controlled trial, crossover study conducted among 32 children aged 5 to 18 years old diagnosed with rheumatic fever and rheumatic heart disease on BPG injection every 21 days over 2 months at MCU-FDTMF Hospital. Subjects were randomly divided into two groups. The first group received an injection of BPG with addition of lidocaine in the diluent for a month then in distilled water over the next month. The other group received the same schedule in reversed order. Blood pressure and heart rate of participants were also determined before injection, immediately and 30 minutes after injection. Pain intensity was assessed using the FLACC Pain Assessment Tool. Results: A statistically significant higher BP was noted among participants who received distilled water as diluent in the 1st month. The systolic BP immediately after (p=0.008) and 30 minutes after (p=<0.001) were elevated as well as their diastolic BP immediately after (p=0.001) and 30 minutes after (p=<0.001). Lower heart rates were noted among those who received additional lidocaine in their diluent immediately after (p=0.003) and 30 minutes after (p=0.02). Higher median pain scores were noted immediately after (p=0.003) and 30 minutes after (p=<0.002) among those who received distilled water in the 1st month and on the 2nd month (p=<0.001). Conclusion: Addition of lidocaine in the diluent of BPG significantly reduced the pain associated with injection, with significant decrease in blood pressure and heart rate.

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