Correspondence to Mohd Hashairi Fauzi (hashairi@usm.my) A RANDOMIZED CONTROLLED TRIAL OF 2 MINUTES ICE COMPRESSION TO REDUCE PRIMARY SCHOOL CHILDREN VENIPUNCTURE PAIN IN AN EMERGENCY DEPARTMENT NORTHEASTERN MALAYSIA Mohd Shahir HASSAN, Mohd Hashairi FAUZI* , Abu Yazid MDNOH Department of Emergency Medicine, School of Medical Sciences, USM, 16150 Kubang Kerian, Kelantan, Malaysia A. BACKGROUND Intravenous cannulation causes iatrogenic pain among children who presented to Emergency Department (ED) for their treatment administration1. Sometime it causes distress worse than the illness itself to the patient. B. AIM OF STUDY To determine the efficacy of ice compression as an analgesic to reduce the pain induced by intravenous cannulation in the primary school children C. METHOD AND MATERIALS A randomized parallel interventional trial was conducted on 60 primary school children that presented to ED Hospital Universiti Sains Malaysia (HUSM), Malaysia. Two groups of children were randomly distributed (Block Randomization) as the interventional and control group. The interventional group received 2 minutes ice compression at the site for their venipuncture on the dorsum of hand prior to the procedure while in the control group venapuncture was performed as usual without any analgesics. Self reporting pain scoring using visual analogue score (VAS) were recorded. The physiological variables were recorded based on the vital signs such as heart rate, respiratory rate, systolic and diastolic blood pressure prior and within 2 minutes after venipuncture procedure completed. a. Respiratory rate-post < Respiratory rate-pre b. Respiratory rate-post > Respiratory rate-pre c. Respiratory rate-post = Respiratory rate-pre   Table 4: Wilcoxon Signed Ranks Test for respiratory rate difference after venipuncture in intervention and control group E. DISCUSSION Ice application provide a great alternatives in reducing pain during venipuncture among school children in hectic ED2. It’s cost and time effective. In fact, the average pain score was comparable to EMLA application study in adults population3. Previous studies have reported no significant differences in physiological variables before and after painful procedure in school children2,4. However in this study, we found significant difference in the mean heart rate between two groups with heart rate being reduced significantly in intervention group. D. RESULTS F. CONCLUSION Ice compression is an effective intervention to reduce pain during intravenous cannulation among primary school children. It is a safe and simple method to be used in ED. *Independant t test Table 1: Comparison of mean pain score, heart rate and systolic/diastolic blood pressure after venipuncture in intervention and control group Taddio, A., Appleton, M., Bortolussi, R., Chambers, C., Dubey, V., Halperin, S., Hanrahan, A., Ipp, M., Lockett, D., MacDonald, N., Midmer, D., Mousmanis, P., Palda, V., Pielak, K., Riddell, R. P., Rieder, M., Scott, J. & Shah, V. (2010). Reducing the Pain of Childhood Vaccination: An Evidence-Based Clinical Practice Guideline. CMAJ, 182(18), 843-855. Movahedi, A. F., Rostami, S., Salsalli, M., Keikhaee, B. & Moradi, A. (2006). Effect of local refrigeration prior to venipuncture on pain related responses in school age children. Australian Journal of Advanced Nursing, 24(2), 51-55. Kuwahara, R. T. & Skinner, R. B. (2001). EMLA Versus Ice as a Topical Anesthetic. Dermatol Surg, 27(5), 495-496. Van–Cleve, L., Jonson, L. and Pothier, P. 1996. Pain responses of hospitalized infants and children to venipuncture and intravenous cannulation. Journal of Pediatric Nursing. 11(3):161-167. Reference SW480 Acknowledgments This study was supported by Universiti Sains Malaysia, Short Term Grant (304/PPSP/61312100). We would also like to thank all patients, lecturers and staffs who have contributed to this study Correspondence to Mohd Hashairi Fauzi (hashairi@usm.my)