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Background: In Norway newly diagnosed children suffering from Acute Lymfoblastic Leukamia (ALL), receive Erwinaseinjections i.m. (cytostatika: killing leukamia cells) in the fifth week, for 10 consecutive days. Aim: To test the following hypotheses: (1) The children will experience significantly less pain and (2) significantly less anxiety when receiving Xylocain in the needle before Erwinase, compared to placebo (normal saline) before Erwinase. Design: An experimental study (randomized, doubleblinded, placebo-controlled, cross over). Subjects: 12 children were included (June 1996 until December 1998). The childrens´ age was median 5.5 years (range 4-12 years). Criteria for participation were: 1) Newly diagnosed children with ALL, 2) Norwegian speaking children and parents, 3) Age from 4 years. Participation was 75% (12/16). Procedures: On one of the two first days of the Erwinase course, the children received 0.5 ml Xylocain (10 mg/ml) through the needle. After 0,5 minute Erwinase was given (1 minute injection). The other day they received 0.5 ml placebo before Erwinase (median 1.2 ml, range 0.95 - 1.90 ml) (10 000 E in 0.5ml normal saline). All received LidocainePrilocaine emulsion, EMLA). Instruments: Three different selfrating Faces Pain Scales (FPS) were used. The anchoring points were: no pain and most pain possible (Baker and Wong, Bieri, Kuttner and Lepage). We also used a Kuttner and Lepage scale, suitable to rate anxiety. The children were interviewed. Analysis: Wilcoxon one sample test was used to test the hypotheses, and Spearman rank correlation was used for some additional analyses. Results: When the children had experienced both types of injections, they rated the procedure where Xylocain was used before Erwinase injections, as significantly less anxious (p= 0.013), compared to placebo before Erwinase. Regarding the painratings, no significant differences were found, neither after experiences of both injections, nor after immediate daily ratings

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