This trial is a comparison of the anesthetic effectiveness of J-Tip needle-free jet injection of 1% buffered lidocaine to the anesthetic effectiveness of topical 4% ELA-Max for peripheral intravenous catheter (PIV) insertion. The researchers hypothesize that the jet injection of lidocaine will provide superior anesthesia to the ELA-Max prior to PIV insertion.

A prospective, block-randomized, controlled trial comparing J-Tip jet injection of 1% buffered lidocaine to a 30-minute application of 4% ELA-Max for topical anesthesia in children 8-15 years old presenting to a tertiary care pediatric emergency department for PIV insertion. All subjects recorded self-reported Visual Analogue Scale (VAS) scores for pain at time of enrollment and pain of PIV insertion. Jet injection subjects also recorded pain of jet injection. Subjects were videotaped during jet injection and PIV insertion. Videotapes were reviewed by a single blinded reviewer for observer-reported VAS pain scores for jet injection and PIV insertion.

Inclusion Criteria:

• Between the ages of 8-15 years requiring a PIV as part of their management in the emergency department.

Exclusion Criteria:

• Excluded from the study if they reported use of analgesic medication within 6 hours of enrollment,
• Had a Glasgow Coma Score < 15,
• A baseline screening VAS pain score > 20 mm, or
• A history of skin hypersensitivity or lidocaine allergy,
• Were incapable of self-reporting a pain score,
• Had a known neurological condition that alters pain perception,
• Had methemoglobinemia, or
• Did not speak or understand English.