title: Effects of dexmedetomidine on procedural pain and discomfort associated with central venous catheter insertion.
abstract: OBJECTIVE
  Central venous catheter (CVC) insertion induces pain and discomfort to a conscious patient despite application of a local anaesthetic (LA) field block and this pain can be greatly lessened by using additional analgesics. The aim of this study was to evaluate the efficacy of dexmedetomidine along with LA field infiltration in controlling pain and discomfort associated with CVC insertion.
  
  
  METHODS
  A prospective, randomised, double-blind, placebo-controlled trial of 54 patients scheduled for planned CVC insertion was undertaken. Patients were randomly assigned into two groups of 27 each, to receive either dexmedetomidine (1 μg/kg) or 0.9% normal saline, along with LA field infiltration. Pain and discomfort score was measured at 5 time points.
  
  
  RESULTS
  The median pain score was worst for placebo group at local anaesthetic injection (6 [4-7]) and at the end of procedure (5 [4-5]), which was significantly attenuated in the dexmedetomidine group (4 [4-5] and 4 [3-5]; P = 0.007 and 0.040 respectively). The lower procedure related discomfort score in the immediate post-procedural period was statistically significant in dexmedetomidine group compared to placebo (4 [4-5] vs. 5 [4-6]; P = 0.008).
  
  
  CONCLUSIONS
  Pre-procedural bolus dexmedetomidine infusion provides adequate analgesia and patient comfort for CVC insertion along LA field block. However, the tendency for excessive sedation and bradycardia associated with dexmedetomidine render it less desirable for this purpose.
authors.affiliation: Department of Anaesthesiology and Critical Care, Sri Venkateswara Institute of Medical Sciences, SVIMS University, Tirupati, Andhra Pradesh, India.
authors.forename: Aloka
authors.initials: A
authors.lastname: Samantaray
keywords: Analgesia; central venous catheter; dexmedetomidine; procedural pain