title: Comparison of local anesthetic effect of lidocaine by jet injection vs needle infiltration in lumbar puncture.
abstract: BACKGROUND
  Usual routes of drug administration are often painful and invasive. Nowadays, using jet injection has been introduced successfully, as a noninvasive and painless method of anesthetic delivery in performing different procedures.
  
  
  OBJECTIVE
  The objective of the study is to compare the local anesthetic effect of lidocaine by jet injection vs needle infiltration in performing lumbar puncture in the emergency department (ED).
  
  
  METHODS
  A randomized single-blind controlled study was performed in 65 patients needing lumbar puncture recruited from the ED from July to November 2014. We enrolled 44 patients and excluded 21 patients by the exclusion criteria. Local lidocaine was delivered in 1 group by jet injector (group B), whereas in the other group conventional method, needle infiltration was used (group A). In both groups, intravenous midazolam 1 mg was administered as an anxiolytic drug before the procedure. Patients' pain score (visual analog scale [VAS]) from 0 to 10 was recorded both during drug delivery and performing the procedure itself. The observer who collected patients' data and fulfill the questionnaire was blinded to the study.
  
  
  RESULTS
  During lidocaine injection, the mean ± SD VAS score was 5.27 ± 1.77 in group A and 2.95 ± 1.81 in group B (mean difference, 2.31; 95% confidence interval, 1.22-3.41) (P= .000). During performing the procedure, the mean ± SD VAS score in groups A and B was 3.77 ± 1.77 vs 2.18 ± 1.50 (mean difference, 1.59; 95% confidence interval, 0.59-2.58) (P= .003).
  
  
  CONCLUSIONS
  Injecting lidocaine by jet injector is less painful than infiltrating it by needle and syringe.
authors.affiliation: Emergency Medicine Department, Shahid Sadoghi University of Medical Sciences, Yazd, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Hajimaghsoudi
authors.affiliation: Emergency Medicine Department, Tehran University of Medical Sciences, Emergency Medicine Research Center, Shariati Hospital, Tehran, Iran.
authors.forename: Elnaz
authors.initials: E
authors.lastname: Vahidi
authors.affiliation: Emergency Medicine Department, Tehran University of Medical Sciences, Emergency Medicine Research Center, Shariati Hospital, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Momeni
authors.affiliation: Emergency Medicine Department, Tehran University of Medical Sciences, Emergency Medicine Research Center, Shariati Hospital, Tehran, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Arabinejhad
authors.affiliation: Emergency Medicine Department, Tehran University of Medical Sciences, Emergency Medicine Research Center, Shariati Hospital, Tehran, Iran. Electronic address: m_saeedi@tums.ac.ir.
authors.forename: Morteza
authors.initials: M
authors.lastname: Saeedi
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007277:Injections, Jet; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D016037:Single-Blind Method; D013129:Spinal Puncture / Q000009:adverse effects*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine