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J Anesth. 2013 Jun;27(3):407-11. doi: 10.1007/s00540-012-1540-1. Epub 2012 Dec 14.

Comparison of the use of the Valsalva maneuver and the eutectic mixture of local anesthetics (EMLA®) to relieve venipuncture pain: a randomized controlled trial.

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  • 1Department of Anesthesiology and Reanimation, Medical Faculty, Gaziosmanpasa University, 60300, Tokat, Turkey, mustafasuren@yahoo.com.



Intravenous cannulation is a painful and stressful procedure. The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics (EMLA(®)) with that of the Valsalva maneuver in adult patients during i.v. cannulation.


One hundred ninety-five patients were randomized prospectively to three groups. The dorsum of the nondominant hand was covered with a thick paste of 2.5 g of EMLA(®) cream in the EMLA(®) group (group E) and left for a minimum of 30 min before venipuncture. In the control group (group C), the same procedure was applied except that Vaseline(®) was used instead of the EMLA(®). The Valsalva group (group V) were punctured during a Valsalva maneuver. The patients were placed in the supine position during venipuncture. The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale (NRS; 0 = no pain, 10 = extreme pain).


Thirteen patients were excluded from the analysis due to failed cannulation. There was no difference in the demographic profiles of the groups (p > 0.05). The success of VP was significantly higher in group V than in groups E and C (p < 0.001). The median pain score as assessed by the NRS after venipuncture in group C was 3 (range 0-9), whereas the median pain values in groups E and V were 2 (range 0-7) and 2 (range 1-8).


The Valsalva maneuver yields similar results to the EMLA(®) in terms of pain reduction during venipuncture.

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