Towards a pain‐free venepuncture

Abstract

SummaryA randomised, prospective trial was conducted to assess the efficacy of various means of alleviating the pain of subcutaneous lidocaine infiltration. One hundred and twenty-two patients were randomly allocated to different groups to receive buffered lidocaine 1%, warmed lidocaine 1% or infiltration by the counter-irritation technique. A visual analogue pain score was recorded at different stages of cannulation and results showed that pain scores were significantly lower in the group receiving buffered lidocaine 1% (p`0.02) and in the counter-irritation group (p`0.05). Thus buffering lidocaine 1% and administration of lidocaine 1% by the counter-irritation technique is effective in relieving the pain of lidocaine infiltration.Keywords Anaesthetic, local; lidocaine. Procedures, venepuncture. ...................................................................................... Correspondence to: Dr E. L. Ong Accepted: 27 February 1999 It is common practice for anaesthetists to use a subcutaneous infiltration of lidocaine to alleviate the pain of venepuncture with a cannula. While previous studies have shown this to be less painful than insertion of a cannula, even one as small as 22-gauge [1], the pain associated with lidocaine infiltration has at times led to debate about this procedure. It was, therefore, the need to alleviate the 'lidocaine sting' that prompted this study, which compares various means of reducing this pain. Well-tested methods include alkalinisation of lidocaine with sodium bicarbonate solution and warming the lidocaine to body temperature. A less well-known method, counter-irritation, has been suggested to be effective [2]. Previous studies with volunteers have performed testing on the forearm [3, 4], this study aims to test the efficacy of these pain-reducing methods on the dorsum of the hand of patients, which is the common site of venous cannulation. A previous study has shown that the skin sensitivity of different parts of the arm vary with the dorsum of the hand being less sensitive than the volar aspect of the arm. If this is the case it may not be necessary to go to lengths to alleviate lidocaine sting [5]. MethodsAfter approval by the hospital ethics committee and informed consent, 122 unpremedicated ASA grade I and II patients were enrolled into the study. Exclusion criteria included allergy to local anaesthetics and pregnancy. The patients were randomly assigned to one of four treatment groups. Groups A and D received 1% lidocaine at room temperature (20 ЊC) as was the standard practice. Group B received 1% lidocaine buffered by adding 8.4% sodium bicarbonate in the ratio of 1-10 of lidocaine. Group C received 1% lidocaine warmed to 37 ЊC by means of a thermostatically controlled water bath available in all operating theatres.The dorsum of the nondominant hand was cleansed with an alcohol swab and allowed to dry. A quantity (0.5 ml) of the prepared solution in a 2.5-ml syringe was infiltrated subcutaneously via a 27-gauge needle over 5 s. In group D, counter-irritation ...

The effect of local cooling on pain perception during infiltration of local anaesthetic agents, a prospective randomised controlled trial*

“…Whereas a multitude of investigators have championed other techniques such as altering the rate of infiltration [14,36], distraction methods, buffering [16-19, 37, 38] and warming the anaesthetic agents [39][40][41][42] in a variety of settings, there is no clear consensus as to the best method to reduce infiltrative pain, as no-one has sought to combine all these techniques in a prospective randomised study. Some studies have demonstrated that warm buffered anaesthetic agents induce less pain during infiltration than either warmed or buffered agents used in isolation, and that buffering solutions is preferable to warming the anaesthetic agents [9,12,13]. However, it is difficult to make comparisons between these studies as considerable heterogeneity exists in the volume of infiltrate, the technique and anatomical location of infiltration, and the method of warming and buffering procedures.…”

“…These include application of topical analgesics such as amethocaine [10], distraction techniques [11], counter irritation [12], warming the anaesthetic agents [13], varying rates of infiltration [14] and buffering the local anaesthesia [9,[15][16][17][18][19].…”

Local anaesthesia for venous cannulation and arterial blood gas sampling: are doctors using it?

“…The pain of local anaesthetic injection is only 1-2/10 in severity, and thereafter the procedure of venous cannulation or ABG sampling should be virtually painless. 1,6,7 If the pain of initial injection is deemed an issue, various ways to lessen it have been suggested including buffering with sodium bicarbonate to reduce acidity, 12 warming of the solution, 13 and injection via a 27G needle of the sort used for subcutaneous insulin.…”

Administration of Local Anaesthetic Before Intravenous Cannulation Reduces Cannulation Pain in the Emergency Department.

“…6(1), 399-405 400 process. 6 Various methods are used including topical ethyl chloride, eutectic mixture of local anaesthetic (EMLA), intradermal or subcutaneous (SC) Lignocaine (lidocaine). 8 All have been shown to significantly reduce cannulation pain.…”

“…1 Local anaesthetic to relieve the pain of intravenous cannulation is widely used in paediatric and some anaesthetic practice. [1][2][3][4][5][6][7] The procedure is associated with pain, anxiety and frustration in patients and changes in hemodynamic parameters. Studies have shown that the use of local anesthesia decreases the pain of I /V cannulation.…”