# A Comparative Study on Pain Perception in Children, After Application of Pre-Cooled and Plain Topical Anaesthetic Gel During Local Anaesthetic Administration—A Parallel Three-Arm Randomised Control Trial

## TL;DR

This study compared pain levels in children using pre-cooled, plain, or ice pack methods for local anesthesia and found pre-cooled gel was most effective.

## Contribution

The study introduces pre-cooled topical anesthetic gel as a novel method for reducing pain during local anesthesia in children.

## Key findings

- Pre-cooled gel showed significantly lower pain scores compared to plain gel and ice packs.
- Children in the pre-cooled group had better pain management during local anesthesia.
- FLACC and WBS scores varied significantly across the three groups.

## Abstract

Background: Effective pain management in children is essential, particularly when administering local anaesthesia. This study was undertaken to compare pain perception in children after application of pre-cooled and plain topical anaesthetic gel during local anaesthetic administration. Methods: A randomised, single-blinded controlled trial was conducted among 51 children between the ages of 6 and 12, visiting the paediatric clinic, Jazan (REC-45/10/1070). Children were allocated into one of the following three groups using a simple randomisation having a 1:1:1 allocation ratio into Group I (n = 17): Plain topical anaesthetic gel, Group II (n = 17): Pre-Cooled topical anaesthetic gel, and Group III (n = 17). An ice pack was applied for a period of 1 min at the injection site. The intensity of pain and the behaviour of the children were assessed using Face, Leg, Activity, Cry, Consolability (FLACC), the Modified Wong–Baker Scale (WBS) and the Frankel Behaviour Rating Scale (FBRS). Results: A significant difference in FBRS scores was observed during anaesthesia, with the highest median score [3 (3,3)] in the pre-cooled topical anaesthetic gel group (p value < 0.001). FLACC scores varied significantly among groups, with the ice pack group [3 (3, 3)] and [4 (4, 5)] showing the highest median score (p value < 0.001). WBS scores also differed significantly between groups (p value < 0.001) with a lower value in the pre-cooled topical gel group [0 (0, 0), 2 (0, 2)]. Conclusions: This study concluded that, the use of a pre-cooled topical anaesthetic gel before LA administration reduced the pain better than that of plain anaesthetic gel and ice pack application at the injection site during infiltration.