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Placement of IV catheters is a painful and stressful procedure for children. J-Tip® is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip® versus eutectic mixture of local anesthetics (EMLA®) to facilitate IV cannulation and provide adequate analgesia before IV placement. Children 7–19 years of age (n = 116) were randomized to receive 0.25 mL of 1% buffered lidocaine with J-Tip® (n = 57) or 2.5 g of EMLA® (n = 59) before IV cannulation. Measurements of success of cannulation (number of attempts for IV placement) and pain (0–10 visual analog scale) at application of local anesthetic and at cannulation were performed. There was a significant (P = 0.0001) difference in pain ratings during IV cannulation between EMLA® (median = 3) and the J-Tip® (median = 0). Eighty-four percent of patients reported no pain at the time of J-Tip® lidocaine application compared to 61% in the EMLA® group at the time of dressing removal (P = 0.004). We did not find differences in the number of attempts for IV cannulation. J-Tip® application of 1% buffered lidocaine before IV cannulation is not painful and has better anesthetic effectiveness compared with EMLA®.