A Randomized, Crossover Comparison of Injected Buffered Lidocaine, Lidocaine Cream, and No Analgesia for Peripheral Intravenous Cannula Insertion - 14/09/13
, Chuan Zhou, PhD b, Linda Robert, MSN c, Alan Storrow, MD a, Robert Kennedy, MD d
Address for correspondence: Candace McNaughton, MD, Vanderbilt University, Department of Emergency Medicine, 1313 21st Avenue S, 703 Oxford House, Nashville, TN 37232-4700; 615-936-0087, Fax 615-936-1316Résumé |
Study objective |
We compare pain and anxiety associated with peripheral intravenous (IV) cannula insertion after pretreatment with no local anesthesia, 4% lidocaine cream, or subcutaneously injected, buffered 1% lidocaine.
Methods |
In a randomized, crossover design, 3 peripheral IVs were inserted in each of 70 medical students or nurses. In random order, insertion sites were pretreated with nothing, lidocaine cream, or injected, buffered lidocaine. After each IV insertion, subjects recorded pain, anxiety, and preference (as patient and provider) for each technique on a 10-point numeric rating scale. Higher scores indicated greater pain, anxiety, and preference.
Results |
Median pain scores (interquartile range [IQR]) were 7 (4 to 8) without local anesthesia, 3 (2 to 5) with lidocaine cream, and 1 (1 to 2) with injected, buffered lidocaine. Median anxiety scores (IQR) were 4 (2 to 7) without local anesthesia, 2 (1 to 4) with lidocaine cream, and 2 (1 to 3) with injected, buffered lidocaine. There was no detectable difference in anxiety scores between lidocaine cream and injected, buffered lidocaine. Most IV placement attempts were successful, regardless of technique. Seventy percent of subjects indicated they would “always” request buffered lidocaine for peripheral IV insertion.
Conclusion |
In adult health care providers, pain and anxiety associated with peripheral IV insertion is significantly reduced by using topical lidocaine cream or injected, buffered lidocaine. Injected, buffered lidocaine reduces IV insertion pain more than lidocaine cream, without affecting success. Adults desire the use of local anesthetic techniques for IV insertion for themselves and for their patients.
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| Supervising editor: Steven M. Green, MD |
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| Author contributions: CM and RK conceived the study and designed the trial. RK obtained materials for the study. CM, LR, and RK supervised the conduct of the trial and data collection. RK undertook recruitment of participants. CM and RK managed the data, including quality control. CZ analyzed the data. CM and RK drafted the article; CM, CZ, LR, AS, and RK all contributed substantially to its revision. CM takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. |
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| Publication date: Available online February 13, 2009. |
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| Reprints not available from the authors. |
Vol 54 - N° 2
P. 214-220 - août 2009 Retour au numéro
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