Easing the Sting: A Paired Crossover Study Comparing Pain Relief with EMLA Cream vs Digital Distraction During Pediatric IV Cannulation

Background Intravenous (IV) cannulation is among the most common and distressing procedures in pediatric care. Eutectic Mixture of Local Anesthetics (EMLA) cream is a widely used pharmacological analgesic, while Digital Distraction (DD) is a feasible non-pharmacological strategy in low- and middle-income settings. However, high-quality comparative evidence—particularly using a paired, crossover design—is limited. This study compared the effectiveness of EMLA cream versus standardized digital distraction in reducing procedural pain during pediatric IV cannulation. Methods This quasi-experimental non-randomized paired crossover study, reported in accordance with the TREND guidelines, was conducted in the Pediatric Care Unit of a tertiary-care teaching hospital in Northern India. Children aged 5–12 years requiring two IV cannulations were enrolled. Allocation of the first intervention was made based on parental preference, and each child subsequently crossed over to receive the alternate method at the next clinically indicated cannulation. EMLA was applied 45–60 minutes before cannulation. DD consisted of standardized offline age-appropriate cartoon videos shown 10–15 minutes before, during, and after cannulation. Pain was assessed at 0, 1, and 3 minutes post-insertion using the Wong–Baker FACES Pain Rating Scale (WBFPS). Pain assessments were performed by a blinded independent observer scoring video-recorded facial expressions. Paired comparisons were analyzed using the Wilcoxon signed-rank test, with a 1-point non-inferiority margin which was defined a priori. Results A total of 161 children completed both intervention phases. Pain scores were consistently lower with EMLA at all three time points. Median paired differences favored EMLA at 0 minutes (EMLA: 8 [IQR 6–10] vs. DD: 8 [6–10]), 1 minute (EMLA: 8 [4–10] vs. DD: 8 [6–10]), and 3 minutes (EMLA: 6 [4–8] vs. DD: 6 [4–8]), with significantly smaller increases from baseline in the EMLA phase (p < 0.001 across all time points). The upper bounds of the 95% confidence intervals exceeded the 1-point non-inferiority margin; DD was not non-inferior. No adverse events occurred. Conclusion In this crossover study, EMLA cream provided superior procedural analgesia compared with digital distraction at all post-cannulation time points. While DD offered partial pain reduction, it did not achieve non-inferiority and may be best used as an adjunct in settings where topical anesthetics are unavailable or impractical. Combined application of pharmacological and digital distraction strategies may offer optimal pediatric comfort during IV procedures.