One Needle is Better Than Two: The Philosophy Surrounding Use of Local Anesthesia in Northern India

Abstract

The author, an internal medicine resident in the United States, participated in an international elective through her postgraduate training program in a rural hospital in northern India. While performing a thoracentesis, she notes that local anesthesia has not been administered, which is seemingly the standard of care at this hospital. Several questionnaire studies about pain services and pain management in India are reviewed, and they reveal insights and severe limitations to effective management of hospitalized patients' pain.

Comparing the Effect of Lidocaine-Prilocaine Cream and Infiltrative Lidocaine on Overall Pain Perception During Thoracentesis and Abdominocentesis: A Randomized Clinical Trial

“…Lidocaine, by blocking sodium channels, can induce an analgesic effect when injected locally (20,21). However, on occasion, medical staff neglect pain management procedures due to the belief that two needles cause more harm than one (5). In view of the systemic adverse effects associated with infiltrative analgesics, it is important to consider the efficacy of topical analgesics compared to the standard practice.…”

“…During thoracentesis and abdominocentesis, pain management is routinely managed with 1% lidocaine with a 25 gauge needle for skin and a smaller gauge needle for deeper tissue (2,3). As the anesthetic injection is painful in and of itself (4), during these two procedures, pain management can sometimes fall short due to a lack of education and incorrect personal opinions (1,5). One such example is "one needle insertion can cause less pain than two-needle insertions" (5).…”

“…As the anesthetic injection is painful in and of itself (4), during these two procedures, pain management can sometimes fall short due to a lack of education and incorrect personal opinions (1,5). One such example is "one needle insertion can cause less pain than two-needle insertions" (5). There-fore, it is essential to find an alternative method that is painless and reduces procedural pain, which does not require expertise to administer.…”