title: Use of local anesthesia for arterial punctures.
abstract: BACKGROUND
  Except for intravenous therapy, arterial access is the most common invasive procedure performed on critically ill patients. Arterial puncture is a source of pain and discomfort. Intradermal injection of lidocaine around the puncture site decreases the incidence and severity of localized pain when used before arterial puncture.
  
  
  OBJECTIVE
  To review the recommendations and studies related to the use of intradermal lidocaine to decrease pain during arterial punctures.
  
  
  METHODS
  Articles were identified by doing a systematic computerized search of MEDLINE (1980 to January 2006) to evaluate articles and reference lists of articles and a manual search of the references listed in original and review articles. English-language articles that evaluated any aspect of pain related to arterial puncture and cannulation, pain related to and methods of introducing lidocaine subcutaneously, and perceptions and use of local anesthesia for arterial or intravenous punctures were reviewed.
  
  
  RESULTS
  Except among anesthesia providers, the use of a local anesthetic before arterial puncture is not universal, contrary to the standard of practice. A number of false perceptions may prevent wider use of such anesthetics.
  
  
  CONCLUSIONS
  Before a plan for behavior modification or policy change is recommended for use of local anesthesia to decrease pain associated with arterial puncture, further research must be done to determine nurses' perceptions of use, actual practice, and currently established local policies.
authors.affiliation: US Army, Fort Bragg, NC 28307, USA. timothy.hudson@us.army.mil
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Hudson
authors.forename: Susan F
authors.initials: SF
authors.lastname: Dukes
authors.forename: Karen
authors.initials: K
authors.lastname: Reilly
mesh_terms: D000779:Anesthetics, Local / Q000627:therapeutic use*; D001158:Arteries; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011677:Punctures / Q000009:adverse effects* / Q000295:instrumentation
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine