Decreasing the Sting of IN Midazolam with Lidocaine: What's the Best Timing for Administration?

Intranasal (IN) midazolam is often used to help with pain control and anxiolysis in pediatric patients undergoing uncomfortable procedures, yet the administration of midazolam itself is painful. Pretreatment with lidocaine has been shown to reduce that discomfort (Acad Emerg Med 2017; 24:161). In this prospective randomized noninferiority trial, researchers compared distress and pain when IN lidocaine was preadministered versus coadministered with midazolam.

A convenience sample of 55 patients ages 6 months to 7 years undergoing laceration repair were randomized to IN administration of 4% lidocaine followed by midazolam 5 minutes later or simultaneous administration of midazolam and lidocaine. Pain and agitation were assessed using multiple …