title: The use of topical anesthesia during intravenous catheter insertion in adults: a comparison of pain scores using LMX-4 versus placebo.
abstract: BACKGROUND
  Intravenous (IV) catheter placement is an extremely common painful procedure performed in all ages and healthcare settings, more often than not without anesthetics, despite clear research and guidelines demonstrating their effectiveness. This study examined differences in pain scores following topical anesthetic and placebo application, in a sample of healthy adult volunteers experiencing IV catheterization.
  
  
  METHODS
  During this prospective, placebo-controlled, double-blind study, 43 subjects were randomized to receive LMX-4 on one hand and hand cream on the other 30 minutes prior to IV catheterization. Paired t-tests were used to measure the difference in pain scores between hands. Pain scores were reported utilizing a visual analog scale (0-10 cm) immediately after each stick. As a control, the difficulty of the IV stick was rated on a 0-10 cm scale and recorded by the nurse who started the IV.
  
  
  RESULTS
  The mean pain score and standard deviation reported for the LMX-4 hand was 3.2 (SD=2.25, range, 0-8.5 cm), while the placebo hand was 4.67 (SD=2.25, range, 0.25-10 mm). The mean paired difference between LMX-4 and placebo hands was -1.37 (95% CI; -2.2, -0.49); subjects receiving LMX-4 reported clinically as well as statistically significant pain reductions (t=-3.17, p=0.003). When adjusted for difficulty of stick, pain scores continued to remain lower in the LMX-4 hand.
  
  
  CONCLUSIONS
  These findings suggest that the topical use of LMX-4 anesthetic cream is a viable option for reducing the pain associated with IV catheter insertion in adults.
authors: Emergency Department, Northwestern Memorial Hospital, 7742 N. Sheridan Rd #3L, Chicago, IL 60626, USA. nvaldovi@nmh.org
authors: Nadya Cortes
authors: NC
authors: Valdovinos
authors: Christopher
authors: C
authors: Reddin
authors: Cynthia
authors: C
authors: Bernard
authors: Brooke
authors: B
authors: Shafer
authors: Paula
authors: P
authors: Tanabe
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002406:Catheterization, Peripheral; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D010919:Placebos
chemical_list: D000779:Anesthetics, Local; D010919:Placebos; D008012:Lidocaine