{
  "abstract": "BACKGROUND: Vaccination is a cornerstone of pediatric primary care; however, injection-site pain remains a barrier to acceptance and on-time uptake. While applying a eutectic mixture of lidocaine and prilocaine (EMLA) can reduce pain, its 30-60 minutes onset is impractical in high-volume primary-care settings. Brief skin cooling, which reduces peripheral nerve conduction, is effective within seconds and may complement a shortened EMLA application time without compromising analgesia.\n\nAIM: To determine whether 20-minute EMLA plus 30-second ice-pack cooling is non-inferior to the standard 40-minute EMLA for pediatric vaccination pain.\n\nMETHODS: A single-center, parallel-group, open-label, randomized, controlled, non-inferiority trial was conducted with 150 children aged 4-15 years who received a quadrivalent inactivated influenza vaccine (Vaxigrip Tetra, southern-hemisphere formulation; Sanofi Pasteur, Lyon, France). The primary endpoint was the self-reported Wong-Baker FACES Pain Rating Scale score immediately after injection. The non-inferiority margin was +1.4 points (one-sided α = 0.025). An intention-to-treat analysis was performed, with a per-protocol sensitivity check.\n\nRESULTS: All 150 children completed the follow-up (74 in the standard group and 76 in the intervention group). The adjusted mean difference in the pain score immediately after injection (intervention group minus standard group) was -0.30 points (95% confidence interval: -1.00 to 0.50). The upper limit of the 95% confidence interval was below the prespecified non-inferiority margin of +1.4 points. The median preparation time fell from 47 minutes to 27 minutes. All adverse events were grade 1, according to the Common Terminology Criteria for Adverse Events, and self-resolving. Exploratory analyses suggested that there were fewer mild events at 15 minutes in the intervention group (25.0% vs 45.9%, P = 0.010). Caregiver satisfaction was high in both groups.\n\nCONCLUSION: The 20-minute EMLA plus brief skin-cooling regimen was non-inferior to the standard 40-minute regimen for managing pediatric vaccination pain and reduced the preparation time by a median of 20 minutes.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "name": "Paveewan Jiravisitkul"
    },
    {
      "name": "Manunya Tandhansakul"
    },
    {
      "name": "Chanikarn Thongkam"
    },
    {
      "name": "Saraiorn Thonginnetra"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cqyh8r79x16yp.bib",
  "cited_by": 0,
  "doi": "10.5409/wjcp.123652",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13720638/",
  "id": "cqyh8r79x16yp",
  "issns": [
    "2219-2808"
  ],
  "landing_url": "https://doi.org/10.5409/wjcp.123652",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Clinical Trials Study"
    ],
    [
      "openalex",
      "2735|Pediatric Pain Management Techniques"
    ]
  ],
  "openalex": "W7171566875",
  "pdf_url": "https://www.f6publishing.com/Forms/Main/DownloadFile.aspx?type=m&typeid=2&id=123652&filepath=8E31D0401EB18CD6271A9142AB7E05E3E92630C58BBEA259F9A8E145B69C252AE6775668CF78D092",
  "pmcid": "PMC13720638",
  "pmid": "42964789",
  "published": "2026-11-03",
  "publisher": "Baishideng Publishing Group Inc",
  "ris": "https://research.draconitic.com/paper/cqyh8r79x16yp.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T12:21:29Z",
      "native_id": "PMC13720638",
      "source": "pmc",
      "url": "https://doi.org/10.5409/wjcp.123652"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2735|Pediatric Pain Management Techniques",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Shortened eutectic mixture of lidocaine and prilocaine plus skin cooling for pediatric vaccination pain: A randomized non-inferiority trial",
  "title_text": "Shortened eutectic mixture of lidocaine and prilocaine plus skin cooling for pediatric vaccination pain: A randomized non-inferiority trial",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:21:29Z",
  "url": "https://research.draconitic.com/paper/cqyh8r79x16yp",
  "venue": "World Journal of Clinical Pediatrics",
  "versions": []
}