Abstract

Research Article

Intradermal and Subcutaneous Lignocaine for Arterial Blood Gas Sampling: A Randomized Controlled Trial

Charlene Swanevelder, Lila Prasad, Kevin YY Chen, Irene Zeng, Nicola Corna, Anh Nguyen and Conroy Wong*

Published: 19 March, 2024 | Volume 8 - Issue 1 | Pages: 023-028

Introduction: The use of local anesthesia (LA) prior to arterial blood gas sampling is recommended but is not widely used. We tested the hypothesis that intradermal administration of local anesthesia would be as effective as subcutaneous administration in reducing pain from arterial blood gas sampling.
Aims: The primary aim of this study was to evaluate the effect of intradermal and subcutaneous lignocaine on patient-perceived pain during arterial blood gas sampling. The secondary aims were to evaluate if different routes of LA administration had an impact on the difficulty and complications of ABG sampling.
Methods: We undertook a randomized, single-blind, placebo-controlled trial in New Zealand. We enrolled patients attending a nurse-led outpatient oxygen clinic who were 18 to 90 years of age and who had an oxygen saturation of 93% or less at rest. Patients were randomly assigned to receive intradermal 1% lignocaine, subcutaneous 1% lignocaine, or subcutaneous normal saline. Patients and nurse assessors were blinded to the treatment allocation. The primary endpoint was a patient-assessed pain score using a graphic rating scale (0-10).
Results: 135 patients were randomized (54 patients in the intradermal lignocaine group, 54 patients in the subcutaneous lignocaine group, and 27 in the subcutaneous saline group). The mean patient-assessed pain score for the intradermal lignocaine group was 1.8 (+/- 1.1), which was a relative reduction of 47% (95% C.I. 31%-59%, p < 0.0001) from the mean patient-assessed pain score of 3.4 (+/- 1.1) for the subcutaneous saline group. The mean patient-assessed pain score for the subcutaneous lignocaine group was 2.1 (+/- 1.1), which was also a significant relative reduction of 36% (95% C.I. 17%-51%, p = 0.0001) compared to the subcutaneous saline group. Intradermal lignocaine reduced pain more than subcutaneous lignocaine, with a relative pain reduction difference of 20% (95% CI -4%-49%, p = 0.05). Bruising was more frequent in the subcutaneous lignocaine group (9.3%) than in the intradermal (0%) and saline groups (0%). 
Conclusion: Intradermal lignocaine is at least as effective as subcutaneous lignocaine for reducing patient-perceived pain from arterial blood gas sampling and results in less bruising.

Read Full Article HTML DOI: 10.29328/journal.jprr.1001054 Cite this Article Read Full Article PDF

Keywords:

Arterial blood gas; Intradermal lignocaine; Subcutaneous lignocaine; Local anesthesia; Oxygen clinic

References

  1. Sado DM, Deakin CD. Local anaesthesia for venous cannulation and arterial blood gas sampling: are doctors using it? J R Soc Med. 2005 Apr;98(4):158-60. doi: 10.1177/014107680509800405. PMID: 15805556; PMCID: PMC1079439.
  2. Hudson TL, Dukes SF, Reilly K. Use of local anesthesia for arterial punctures. Am J Crit Care. 2006 Nov;15(6):595-9. PMID: 17053266.
  3. Giner J, Casan P, Belda J, González M, Miralda RM, Sanchis J. Pain during arterial puncture. Chest. 1996 Dec;110(6):1443-5. doi: 10.1378/chest.110.6.1443. PMID: 8989058.
  4. Guidelines for the measurement of respiratory function. Recommendations of the British Thoracic Society and the Association of Respiratory Technicians and Physiologists. Respir Med. 1994 Mar;88(3):165-94. PMID: 8209067.
  5. Lynn-McHale Wiegand DJ, Carlson KK. AACN Procedure Manual for Critical Care. Elsevier/Saunders. 2005; https://books.google.co.nz/books/about/AACN_Procedure_Manual_for_Critical_Care.html?id=CyJtAAAAMAAJ&redir_esc=y
  6. Proehl JA. Emergency Nursing Procedures. Elsevier/Saunders. 2004; https://books.google.co.nz/books/about/Emergency_Nursing_Procedures.html?id=xTVtAAAAMAAJ&redir_esc=y
  7. Bates D, Cutting P. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Local anaesthetic and arterial puncture. Emerg Med J. 2001 Sep;18(5):378. doi: 10.1136/emj.18.5.378. PMID: 11559614; PMCID: PMC1725663.
  8. Lightowler JV, Elliott MW. Local anaesthetic infiltration prior to arterial puncture for blood gas analysis: a survey of current practice and a randomised double blind placebo controlled trial. J R Coll Physicians Lond. 1997 Nov-Dec;31(6):645-6. PMID: 9409498; PMCID: PMC5421072.
  9. Giner J, Casan P, Belda J, Litvan H, Sanchis J. Utilización de la crema anestésica EMLA en la punción arterial [Use of the anesthetic cream EMLA in arterial punction]. Rev Esp Anestesiol Reanim. 2000 Feb;47(2):63-6. Spanish. PMID: 10769553.
  10. Pagnucci N, Pagliaro S, Maccheroni C, Sichi M, Scateni M, Tolotti A. Reducing Pain During Emergency Arterial Sampling Using Three Anesthetic Methods: A Randomized Controlled Clinical Trial. J Emerg Med. 2020 Jun;58(6):857-863. doi: 10.1016/j.jemermed.2020.03.027. Epub 2020 Apr 27. PMID: 32354590.
  11. Tran NQ, Pretto JJ, Worsnop CJ. A randomized controlled trial of the effectiveness of topical amethocaine in reducing pain during arterial puncture. Chest. 2002 Oct;122(4):1357-60. doi: 10.1378/chest.122.4.1357. PMID: 12377864.
  12. Aaron SD, Vandemheen KL, Naftel SA, Lewis MJ, Rodger MA. Topical tetracaine prior to arterial puncture: a randomized, placebo-controlled clinical trial. Respir Med. 2003 Nov;97(11):1195-9. doi: 10.1016/s0954-6111(03)00226-9. PMID: 14635973.
  13. Cakmak F, Gur A. Ethyl chloride spray, a local anesthetic in arterial blood gas sampling: A randomized, controlled, double-blinded study. Am J Emerg Med. 2022 Sep;59:63-66. doi: 10.1016/j.ajem.2022.06.038. Epub 2022 Jun 22. PMID: 35797844.
  14. Yıldız İU, Yıldırım Ç, Özhasenekler A, Şener A, Gökhan Ş. Effectiveness of lidocaine spray on radial arterial puncture pain: A randomized double-blind placebo controlled trial. Am J Emerg Med. 2021 Dec;50:724-728. doi: 10.1016/j.ajem.2021.09.077. Epub 2021 Oct 1. PMID: 34879493.
  15. Ekblom A, Hansson P. Pain intensity measurements in patients with acute pain receiving afferent stimulation. J Neurol Neurosurg Psychiatry. 1988 Apr;51(4):481-6. doi: 10.1136/jnnp.51.4.481. PMID: 3259976; PMCID: PMC1032956.
  16. Candiotti K, Rodriguez Y, Koyyalamudi P, Curia L, Arheart KL, Birnbach DJ. The effect of needle bevel position on pain for subcutaneous lidocaine injection. J Perianesth Nurs. 2009 Aug;24(4):241-3. doi: 10.1016/j.jopan.2009.04.003. PMID: 19647661.
  17. Dev SP, Hillmer MD, Ferri M. Videos in clinical medicine. Arterial puncture for blood gas analysis. N Engl J Med. 2011 Feb 3;364(5):e7. doi: 10.1056/NEJMvcm0803851. PMID: 21288091.
  18. Hsu DC, Stack AM, Walls RM, Miller SJ, Ganetsky M. Subcutaneous infiltration of local anesthetics. Uptodate. Cited 18 June 2023. https://www.uptodate.com/contents/subcutaneous-infiltration-of-local-anesthetics.
  19. Scarborough D, Bisaccia E, Schuen W, Swensen R. Anesthesia for the dermatologic surgeon. Int J Dermatol. 1989 Dec;28(10):629-37. doi: 10.1111/j.1365-4362.1989.tb02431.x. PMID: 2592127.
  20. Quaba O, Huntley JS, Bahia H, McKeown DW. A users guide for reducing the pain of local anaesthetic administration. Emerg Med J. 2005 Mar;22(3):188-9. doi: 10.1136/emj.2003.012070. PMID: 15735267; PMCID: PMC1726707.
  21. Palmon SC, Lloyd AT, Kirsch JR. The effect of needle gauge and lidocaine pH on pain during intradermal injection. Anesth Analg. 1998 Feb;86(2):379-81. doi: 10.1097/00000539-199802000-00030. PMID: 9459252.
  22. Long CC, Motley RJ, Holt PJ. Taking the 'sting' out of local anaesthetics. Br J Dermatol. 1991 Nov;125(5):452-5. doi: 10.1111/j.1365-2133.1991.tb14771.x. PMID: 1751351.
  23. Guinard JP, Carpenter RL, Morell RC. Effect of local anesthetic concentration on capillary blood flow in human skin. Reg Anesth. 1992 Nov-Dec;17(6):317-21. PMID: 1286052.
  24. Theodore AC, Manaker S, Finlay G. Arterial blood gases. Uptodate. Cited 20 August 2023. 2023. https://www.uptodate.com/contents/arterial-blood-gases
  25. Rosseland LA, Stubhaug A. Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery. Pain. 2004 Dec;112(3):248-253. doi: 10.1016/j.pain.2004.08.028. PMID: 15561379.
  26. Mcgavock ZC, Barnes HM, Mccreanor T. Māori and pain: A literature review. AlterNative 8(2): 163–175. https://www.researchgate.net/publication/313782693_Maori_and_pain_A_literature_review
  27. Bradley K, Cowan S, Babor R, Morrow J, MacCormack A, Rahiri JL, Murphy R. Investigating the distribution of primary and secondary care referrals for public-funded bariatric surgery at Counties Manukau Health (CMH). N Z Med J. 2023 Jun 16;136(1577):65-75. PMID: 37778320.

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