Introduction: Children with thalassemia need blood transfusion to survive. The intravenous cannulation is a requirement for blood transfusion, which is a painful and frightening procedure and can cause severe anxity. Repeated exposure to severe anxiety have a meaningful relationship with psychological problems in children. Multiple methods introduced or under research to reduce anxiety in children during medical procedure especially intravenous cannulation. The aim of current study is to compare the effect of vapocoolant spray and EMLA cream in reduction of anxiety due to intravenous cannulation.

Methods: This was a controlled randomized clinical trial with crossover design. A convenience sample of 40 children between the ages of 6 and 12
years was enrolled between June and November 2015 in Ali Asghar hospital, Tehran, Iran. After the baseline measurement of anxiety samples were randomly allocated in one of two intervention groups by block randomization. The first group received EMLA cream before intravenous cannulation in the next blood transfusion and vapocoolant spray in the third one. The second group has the opposite arrangement. The anxiety was measured by a self-reported visual analogue scale. Anxiety was measured before and after each cannulation. The data was analyzed using independent t-test, paired t-test, Pearson correlation, ANOVA and ANCOVA tests by SPSS 16.

Results: The results showed that the difference between EMLA cream and vapocoolant spray in reduction of anxiety was 1.94. The same difference between spray and baseline was 2.91. The differences in baseline measurement was 4.86.The vapocoolant spray had a lower effect in reduction of anxiety in compare of EMLA cream (p<0.05(, but it has a significant effect in compare with baseline measurement (p<0.05).

Conclusion: Based on the results of current study, vapocoolant spray can reduce the anxiety of children with thalassemia during intravenous cannulation. Despite the lower effect of spray in compare to EMLA cream, it can use for patients with allergic reaction to lidocaine/procaine or in emergency situations.