A Randomized, Crossover Comparison of Injected Buffered Lidocaine, Lidocaine Cream, and No Analgesia for Peripheral Intravenous Cannula Insertion
Presented at the American College of Emergency Physicians Scientific Assembly, October 2008, Chicago, IL.
Received 11 August 2008; received in revised form 3 December 2008 and 12 December 2008; accepted 16 December 2008. published online 17 February 2009.
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.
aDepartment of Emergency Medicine, Vanderbilt University, Nashville, TN
bDepartment of Pediatrics, University of Washington, Seattle, WA
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.
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.
Publication date: Available online February 13, 2009.
ABSTRACT