Philippine E-Journals

Lidocaine as a Diluent for Benzathine Penicillin for Injection Pain in Children with Rheumatic Fever and Rheumatic Heart Disease: A Randomized Double-Blind Crossover Study

Roxanne M Tamondong | Leah Patricia M. Arceo-Plucena

Discipline: medicine by specialism

 

Abstract:

BACKGROUND: Rheumatic fever (RF) and Rheumatic heart disease (RHD) patients necessitate secondary prophylaxis with benzathine penicillin G (BPG) injection every 3 weeks to prevent recurrences and complications. Patients with rheumatic fever on regular benzathine penicillin G injection usually experience moderate to severe pain resulting to poor compliance to treatment. OBJECTIVES: This study aims to compare the effect of BPG diluted in lidocaine hydrochloride 1% versus diluted water in reducing injection pain in patients with RF and RHD. METHODS: This is a randomized double blind crossover study conducted at the PCMC OPD. Thirtythree patients diagnosed with RF and RHD were divided into 2 groups; the first group received BPG diluted in sterile water followed by BPG diluted in lidocaine hydrochloride 1% after 21 days, the second group received the same medications in reverse order. Pain scale was measured using Universal pain assessment tool immediately after injection. Paired T test was used to compare the pain score results of the two groups. RESULTS: Pain score was significantly less in patients who received BPG diluted in lidocaine hydrochloride 1%; from an average pain score of 4.88 to 0.63 (p<0.0001), among those who received BPG diluted in sterile water. No adverse effects were seen in all patients. CONCLUSION: This study concluded that BPG diluted in lidocaine hydrochloride 1% significantly and safely reduced post injection pain. In all patients diagnosed with RF and RHD, BPG injection should be diluted in lidocaine hydrochloride 1% to decrease injection pain and improve patient’s compliance.