Anaesthesia for arterial puncture in the emergency department: a randomized trial of subcutaneous lidocaine, ethyl chloride or nothing.
OBJECTIVE
To determine whether the use of ethyl chloride and subcutaneous lidocaine are associated with a reduction in pain during arterial blood sampling compared with using no local anaesthesia.


METHODS
Patients over the age of 16 years and who required arterial blood sampling as part of their on-going emergency department management were randomly allocated to one of three groups. Group A received routine skin preparation before arterial puncture (AP); group B received 0.5 ml of 2% lidocaine 2 min before AP; and group C received ethyl chloride immediately before AP. Pain was measured using 100-mm visual analogue scale.


METHODS
Two urban emergency departments.


RESULTS
Fifty-four patients were recruited. Those receiving lidocaine before AP had lower pain scores [10.2 mm, 95% confidence interval (CI): 4.8-16.3 mm] compared with the use of ethyl chloride (23.9 mm, 95% CI: 12.4-35.5 mm) and nothing (23.4 mm, 95% CI: 11.7-35.0 mm). Lidocaine was more painful to administer (22.0 mm, 95% CI: 10.9-33.7 mm) compared with ethyl chloride (12.9 mm, 95% CI: 5.5-20.3 mm).


CONCLUSIONS
Ethyl chloride is not an effective local anaesthetic agent for AP. When the pain of local anaesthetic administration is taken into account the benefit of subcutaneous lidocaine for single AP is limited.
France
James E
JE
Emergency Department, Royal United Hospital, Combe Park, Bath, UK. jfrancemail@yahoo.co.uk
Beech
Fiona J M
FJ
Jakeman
Nicola
N
Benger
Jonathan R
JR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000627:therapeutic use*; D001158:Arteries; D001800:Blood Specimen Collection / Q000009:adverse effects* / Q000379:methods*; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005018:Ethyl Chloride / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D055104:Infusions, Subcutaneous; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D011677:Punctures / Q000009:adverse effects; D016896:Treatment Outcome
D000779:Anesthetics, Local; D005018:Ethyl Chloride; D008012:Lidocaine