title: Establishing intravenous access: a study of local anesthetic efficacy.
abstract: We performed a double-blind, randomized, prospective study to determine the local anesthetic that provided the best analgesia for insertion of an 18-gauge intravenous (i.v.) catheter and to determine whether alkalinization of lidocaine decreases the pain of intradermal injection. There were 280 healthy adult patients assigned randomly to seven different groups: benzyl alcohol 0.9% in normal saline, 2-chloroprocaine 3%, lidocaine 1%, lidocaine 1% with preservative, alkalinized lidocaine 1% with preservative, normal saline, and a control group that received i.v. catheter placement without previous drug injection. A 10-cm visual analog pain scale (VAPS) was used to obtain pain scores after pre-i.v. drug injection and after iv catheter insertion. Benzyl alcohol in normal saline (0.61 +/- 0.11) and alkalinized lidocaine (0.69 +/- 0.10) had the lowest mean pain scores for drug injection and these were significantly different from other drugs (P < 0.05). Alkalinized lidocaine (0.7 +/- 0.18) had the lowest mean pain score for i.v. catheter insertion with nothing (no previous drug injected) (3.47 +/- 0.38) and normal saline (3.97 +/- 0.18) had the highest mean pain scores (P < 0.05). We conclude that alkalinized lidocaine decreased the pain associated with its injection. Alkalinized lidocaine was the best local anesthetic for i.v. catheter placement. Benzyl alcohol in normal saline was also effective.
authors.affiliation: Department of Anesthesiology, 3rd Medical Center, Elmendorf Air Force Base, Anchorage, Alaska.
authors.forename: G A
authors.initials: GA
authors.lastname: Nuttall
authors.forename: M R
authors.initials: MR
authors.lastname: Barnett
authors.forename: R L
authors.initials: RL
authors.lastname: Smith
authors.forename: T K
authors.initials: TK
authors.lastname: Blue
authors.forename: K R
authors.initials: KR
authors.lastname: Clark
authors.forename: B W
authors.initials: BW
authors.lastname: Payton
mesh_terms: D000328:Adult; D000779:Anesthetics, Local; D019905:Benzyl Alcohol; D001592:Benzyl Alcohols; D002406:Catheterization, Peripheral / Q000379:methods*; D002408:Catheters, Indwelling; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008012:Lidocaine; D008297:Male; D010147:Pain Measurement; D011310:Preservatives, Pharmaceutical; D011343:Procaine / Q000031:analogs & derivatives; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D001592:Benzyl Alcohols; D011310:Preservatives, Pharmaceutical; D011343:Procaine; C004616:chloroprocaine; D008012:Lidocaine; D019905:Benzyl Alcohol