Venous Cannulation Pain Research Articles

Laser-assisted Anesthesia Reduces the Pain of Venous Cannulation in Children and Adults: A Randomized Controlled Trial

Laser-assisted Anesthesia Reduces the Pain of Venous Cannulation in Children and Adults: A Randomized Controlled Trial

Laser‐assisted Anesthesia Reduces the Pain of Venous Cannulation in Children and Adults: A Randomized Controlled Trial

Application of topical anesthetics before intravenous (IV) cannulation is effective yet limited by delayed transdermal absorption. The authors evaluated a handheld laser device to enhance topical anesthetic absorption by ablating the stratum corneum, the major barrier to drug absorption through the skin. The hypothesis was that laser-assisted anesthesia would reduce the pain of IV cannulation in emergency department (ED) patients. This was a blinded, randomized, controlled trial. ED patients aged 1 year and older requiring nonemergent IV cannulation were included. Patients were randomized to pretreatment of the skin with laser or sham laser, and standardized venous cannulation was performed on the dorsum of the patients' hands or antecubital fossa. In the experimental group, the area over the target vein was pretreated with a lightweight, portable Er:YAG unit, with a fluence of 3.5 J/cm2, a pulse width of 600 microseconds, and a spot diameter of 6 mm. Lidocaine 4% cream was applied to the area immediately after laser application. Five minutes later, the cream was wiped off and a trained nurse inserted an IV catheter. In the control group, a sham laser and lidocaine were used. Pain of laser application and IV cannulation was recorded on age-appropriate pain scales; presence of infection or abnormal pigmentation was determined at one week. Pain of cannulation was compared using parametric and nonparametric tests. Sixty-one patients were randomized to laser (30) and sham (31) pretreatment. Mean (+/- SD) age was 27 (+/- 21) years, 49% were female, and one half were children younger than 18 years. The mean pain of IV cannulation was significantly less (mean difference, 28.3 mm; 95% confidence interval = 17.9 to 38.7) in patients pretreated with the laser (10.0 mm; 95% confidence interval = 4.4 to 15.6) than with sham laser (38.3 mm; 95% confidence interval = 29.3 to 42.2). The difference in children was also significant. Application of the laser was painless in most patients. No patient developed infection or abnormal pigmentation. Pretreatment of the skin with a laser device followed by a five-minute topical lidocaine 4% application reduces the pain of IV cannulation in ED adult and pediatric patients.

An Evaluation of Efficacy of Balloon Inflation on Venous Cannulation Pain in Children: A Prospective, Randomized, Controlled Study

Venipuncture is the most common painful event for a hospitalized child. We evaluated the efficacy of balloon inflation for attenuating venipuncture pain in children. Seventy-five pediatric patients aged 6-12 yr, ASA physical status I-II, of either sex, undergoing elective surgery were included in this prospective and randomized study. Patients were randomly divided into 3 equal groups of 25 each; Group I (control), Group II (distraction) pressed a rubber ball, and Group III (balloon) inflated a balloon. A manual venous occlusion was applied on the forearm and venipuncture was performed with a 22-gauge venous cannula. Pain was self-reported by a pain face scale with a 10-cm visual analog scale (VAS) placed at its back, where 0 = "no pain" and 10 = "worst imaginable pain." VAS scores of 1-3 were rated as mild, 4-6 as moderate, and >6 as severe. Median (interquartile range) VAS score in the balloon group was 1 (3), which was reduced as compared with 2 (2) and 4 (2) observed in the distraction and control groups, respectively (P < 0.000). Significant reduction in the incidence and severity of venipuncture pain was also observed in the balloon group compared with the other 2 groups (P < 0.05).

Evaluation of a diclofenac transdermal patch for the attenuation of venous cannulation pain: a prospective, randomised, double‐blind, placebo‐controlled study

Venous cannulation, although a minor procedure, is often painful. The present study was planned to evaluate the efficacy of a diclofenac transdermal patch placed over the venepuncture site in decreasing the pain of cannulation. Seventy-two adults undergoing elective surgery were included in this randomised, prospective, double-blind, placebo-controlled study. Patients were divided into three equal groups. The Control group had a placebo adhesive patch placed on the both the dorsum of hand and the buttock; the Diclofenac-Buttock group had a placebo patch placed on the dorsum of the hand and a diclofenac transdermal patch on the buttock; the Diclofenac-Hand group had a diclofenac transdermal patch placed on the dorsum of hand and a placebo patch on the buttock. The patches were applied 1 h before cannulation. An 18G cannula was used for all venous cannulations. Pain during cannulation was assessed on a non-graduated 10-cm visual analogue scale. Median [interquartile range] pain scores were 3.0 [2.0-4.0] in the Diclofenac-Hand group, 5.0 [4.3-7.8] in the Diclofenac-Buttock group and 6.5 [4.5-7.0] in the Control group, p < 0.05. The numbers needed to treat were six and two in the Diclofenac-Buttock and Diclofenac-Hand groups, respectively. The application of a diclofenac transdermal patch at the cannulation site appears to be effective in decreasing cannulation pain.

Evaluating the Efficacy of the Valsalva Maneuver on Venous Cannulation Pain: A Prospective, Randomized Study

Pain associated with venous cannula is a distressing symptom. We evaluated the efficacy of the Valsalva maneuver on pain associated with venous cannulation. Seventy-five adults, ASA physical status I and II, either sex, undergoing elective surgery, were included in this study. Patients were randomized into 3 groups of 25 each. Group I (C): control; Group II (V): blew into sphygmomanometer tubing and raised the mercury column up to 30 mm Hg for 20 s; Group III (B): pressed a rubber ball. Twenty seconds later, peripheral venous cannulation was performed. Venous cannulation pain was graded using a 4-point scale: 0-3, where 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain, and visual analog scale of 0-10, where 0 = no pain and 10 = worst imaginable pain. A significant reduction in the incidence of pain was observed in the Valsalva group: 18 of 25 (72%) patients, whereas 25 of 25 (100%) experienced pain in the other two groups (P < 0.001). A significant reduction in the severity of pain, number of patients in whom one needed to make the vein prominent before cannulation, and the time taken for the same were observed in the Valsalva group (P < 0.001). Venous cannulation is a necessary step for safe anesthesia administration; however, the pain associated with it is sometimes very distressing. We observed that the Valsalva maneuver performed at the time of venous cannulation greatly decreases this pain.

The pain of venous cannulation

Many nurses and physicians seem not to be aware of the difference, even with the finest needle, that a trace of remaining alcohol makes. I would plead with all concerned to allow sufficient time for alcohol to evaporate. It truly can make the difference between a painless shot and a stinging one.

The Pain of Venous Cannulation

The Pain of Venous Cannulation

The pain of venous cannulation

Dr Sado and Dr Deakin (April 2005 JRSM1) refer to some of the practical reasons why ward doctors are less likely than anaesthetists to use local anaesthesia for vein cannulation. One of them is access to lidocaine. On an eight-hour shift a ward doctor might have to insert up to twenty cannulas; and, if on each occasion the lidocaine has to be produced from a locked cupboard by a nurse, time does not permit. However, time is not the issue here. I do not accept Sado and Deakin's conclusion that patients are suffering 'more pain than necessary'. Assessing the effect of local anaesthesia for vein cannulation, Rohm et al.2 in a recent study, found clear benefits for cannulae of 16G or greater but no advantages for 18G (green) and 20G (pink). These smaller cannulae are the ones used most often on the ward. If a 14G cannula is needed, this will probably be an emergency where local anaesthesia would unduly delay treatment. The arguments of Sado and Deakin are hazardous because they could be used unfairly in medicolegal cases. I see no argument for use of local anaesthesia in routine ward cannulation.

The Pain of Venous Cannulation

The Pain of Venous Cannulation

Local Anaesthesia for Venous Cannulation and Arterial Blood Gas Sampling: Are Doctors Using It?

The pain of venous cannulation and arterial puncture can be greatly lessened by local anaesthesia. We sought information about the use of local anaesthesia for these procedures by doctors working in medicine, surgery and anaesthetics. A questionnaire was hand-delivered to 178 doctors in eight hospitals, all of whom responded. For insertion of large-bore cannulae, local anaesthesia was used by all the anaesthetists but less than half the medical and surgical doctors. For arterial blood sampling it was used by 60% of anaesthetists and 2% of ward doctors. Previous recommendations to use local anaesthesia seem to have been ignored, and in many instances these procedures are more painful than necessary.

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

The pain of venous cannulation and arterial puncture can be greatly lessened by local anaesthesia. We sought information about the use of local anaesthesia for these procedures by doctors working in medicine, surgery and anaesthetics. A questionnaire was hand-delivered to 178 doctors in eight hospitals, all of whom responded. For insertion of large-bore cannulae, local anaesthesia was used by all the anaesthetists but less than half the medical and surgical doctors. For arterial blood sampling it was used by 60% of anaesthetists and 2% of ward doctors. Previous recommendations to use local anaesthesia seem to have been ignored, and in many instances these procedures are more painful than necessary.

The use of Local Anaesthesia in Peripheral Venous Cannulation: Current Practice of Junior Doctors

To determine the rate of use of local anaesthetic in peripheral venous cannulation by pre-registration house officers and to determine reasons why they do not use it. Analysis of anonymous questionnaires distributed to pre-registration house officers at scheduled weekly education meetings. One regional hospital and three district general hospitals in the United Kingdom. 71 questionnaires were distributed directly to respondents and subsequently analysed. 46 respondents (65%) stated that they never used local anaesthetic for peripheral venous cannulation. Of those who used local anaesthetic the average rate of use was 6%. Of those who used local anaesthetic 48% stated they used EMLA and 84% stated they used lignocaine. 4% stated they would use local anaesthetic for 22 gauge cannulae, 8% would use it for 20 gauge, 24% for 18 gauge and 40% for 16 gauge and 28% for 14 gauge cannulae. 45% stated that using local anaesthetic was too time consuming, 35% stated it was not indicated, 21% stated that it made cannulation difficult, 13% stated that local anaesthetic was not available on the ward, 13% stated that it was logistically difficult, 4% stated that there was peer pressure not to use it, 4% stated they were not allowed to use local anaesthetic and 3% stated that it was practically difficult. 20% of respondents gave no reason. Despite good clinical evidence that the pain of peripheral venous cannulation can be successfully obviated using local anaesthetic, the rate of use by pre-registration house officers is low. It is suggested that during formal cannulation training, more emphasis be placed on the provision of analgesia. This should aim to increase the quality of care to those patients requiring intravenous cannulation as well as offering other potential benefits to doctors.

Evaluation of an amethocaine gel preparation for percutaneous analgesia before venous cannulation in children

We have evaluated the efficacy and safety of a preparation of 4% amethocaine gel in alleviating the pain of venous cannulation in children. In an initial open study of 148 children, clinically acceptable anaesthesia was achieved in 92% of cases. The preparation was then compared with 5% EMLA cream in a single-blind study in 94 patients using an application time of 40 min. We found clinically acceptable conditions in 85% of patients receiving amethocaine gel compared with 66% in the EMLA group. There were no significant adverse effects noted in each group, although 37% of those children treated with amethocaine gel showed localized erythema at the application site. The results suggest that amethocaine gel has greater efficacy and a faster onset time than EMLA cream when used for this purpose in children.

Evaluation of the efficacy and safety of amethocaine gel applied topically before venous cannulation in adults

We have assessed in a placebo-controlled, double-blind trial, the efficacy and safety of an amethocaine gel preparation for alleviating the pain of venous cannulation. Forty-two unpremedicated adult patients were allocated randomly to receive either amethocaine gel 1 g (4% w/w) or placebo gel 1 g applied to the dorsum of the hand for 40 min before venous cannulation. After removal of the gel, a 20-gauge cannula was inserted and the pain of cannulation assessed by a three-point rank score and a 100-mm visual analogue scale: 90% of patients who received amethocaine reported clinically acceptable topical anaesthesia. Both verbal rating scores and visual analogue scores for pain were significantly less with amethocaine. Slight erythema associated with amethocaine occurred in one patient and slight itching in two patients. No other adverse features were evident.

Comparison of percutaneous anaesthesia for venous cannulation after topical application of either amethocaine or EMLA cream

We have compared, in a double-blind study, the efficacy of topical amethocaine cream 1 g (5% w/w) in alleviating the pain of venous cannulation with that of 5% EMLA cream 2.5 g. One hundred and twenty unpremedicated female patients undergoing minor gynaecological surgery, were allocated randomly to one of four groups: 5% EMLA cream 2.5 g for 30 min: 5% EMLA cream 2.5 g for 60 min; amethocaine cream 1 g (5% w/w) for 30 min; amethocaine cream 1 g (5% w/w) for 60 min. After removal of the cream, venous cannulation was performed with an 18-gauge cannula. Patients assessed the pain experienced using a 100-mm visual analogue score and four-point rank score. In addition, a blinded observer assessed the patient's response to venous cannulation using a four-point rank score. Good analgesia was obtained in all groups and there was no statistically significant difference in pain scores between the groups.

DOUBLE-BLIND EVALUATION OF A LIGNOCAINE-PRILOCAINE CREAM (EMLA) IN CHILDREN: Effect on the Pain Associated with Venous Cannulation

The effect of the topical application of a lignocaine-prilocaine cream (EMLA) on the pain of venous cannulation was tested in a double-blind manner. Sixty boys and girls between the ages of 4 and 10 yr who were to undergo surgery participated in the study. No analgesic premedication was given and the venous cannulation was performed during the preparation for general anaesthesia. Pain was assessed by the anaesthetist and the patient using a verbal rating scale and two different pictorial scales. The effect of EMLA in the alleviation of the pain of venous cannulation was considered significantly better than placebo by both anaesthetist (P less than 0.001) and patient (P less than 0.05) (verbal scales). One conventional pictorial scale showed a statistically significant difference (P less than 0.05), but the other, based on facial expressions, did not. Local reactions to the cream were minor and transient in both groups.