[The authors respond:]
Conrad Fernandez and Gerri Frager's claim that it is wrong to expose patients to “unnecessary procedural pain” would be correct if in the practice of emergency pediatrics children routinely received EMLA,® Ametop® or similar products. In reality, most venipunctures in Canadian pediatric emergency departments are performed without any local anesthetics. In initiating this study, the question that our research ethics board and ourselves had to ask was “What is the routine, standard practice in our emergency department”? In our hospital, children did not routinely receive topical anesthesia. The reason was that it was believed to interfere with cannulation success. Since previous studies had not addressed this question, a placebo-controlled trial was necessary to disprove this belief.