Since the beginning of the COVID-19 pandemic, nasopharyngeal swabs (NPS) have been recommended to detect the virus. This procedure has been reported to be painful by 85% of children The aim of the study was to assess whether pretreatment with topical lidocaine reduces the discomfort experienced by children during a nasopharyngeal swab.

This was a RCT among children aged 8-17 years old who need a NPS. The primary outcome was pain intensity as measured by the Visual Analog Scale .

Inclusion:

• 6-17 years old inclusively
• Children for whom a NPS was ordered

Exclusion:

• Children presenting with the following acute conditions, which could either prevent the lidocaine from being properly administered, or pose a risk for the patient as increased absorption of the medication might occur:

  • Nasal or airway burns, trauma or major anomaly
  • Cardiorespiratory compromise

• Children for whom an informed consent could not be obtained

  • Any other life-threatening condition or priority one patient requiring emergency support
  • Language barrier

• Children presenting with conditions that could prevent their ability to reliably report their pain:

  • Severe intellectual disability
  • Severe pain upon presentation
  • Administration of opiates prior to the NPS

• Children presenting with the following chronic conditions, which could either prevent the lidocaine from being properly administered, or pose a risk for the patient:

  • Hypersensitivity/allergy to the medication or a known component
  • Methemoglobinemia
  • G6PD deficiency
  • Familial malignant hyperthermia
  • Pseudocholinesterase deficiency
  • Severe hepatic impairment
  • Severe cardiac condition or use of antiarrhythmic medication
  • Risk of airway aspiration

The research assistant enrolling the patients was blinded to treatment assignment because he did not know to which bottle the patient was randomized (A or B) and he did not know what was contained in the bottle