title: Vapocoolant Spray Versus Lidocaine Infiltration for Radial Artery Cannulation: A Prospective, Randomized, Controlled Clinical Trial.
abstract: OBJECTIVE
  Local infiltration with lidocaine is a frequently used measure to prevent pain during arterial cannulation. Its administration is associated with pain. Vapocoolants like ethyl chloride or alkanes also affect rapid-onset anesthesia. However, their administration causes less discomfort compared with administration of lidocaine. The effectiveness of vapocoolants in mitigating discomfort associated with arterial cannulation never has been studied. The authors therefore compared vapocoolant with lidocaine for reducing discomfort caused by arterial cannulation.
  
  
  METHODS
  Prospective, randomized, controlled study.
  
  
  METHODS
  University hospital, single center.
  
  
  METHODS
  One hundred sixty adult patients requiring arterial cannulation before induction of general anesthesia for cardiac surgery or carotid endarterectomy.
  
  
  METHODS
  Patients received either lidocaine infiltration or vapocoolant spray prior to arterial cannulation. Overall discomfort resulting from the whole procedure (applying local/topical anesthesia followed by arterial puncture) was rated on a 0 to 10 numerical rating scale. Puncture failure rate and time required for the intervention also were recorded.
  
  
  RESULTS
  One hundred forty-three patients were included in the per-protocol analysis. Mean pain scores in the vapocoolant group were 3.4 (±1.58) compared with 4.5 (±2.29) in the lidocaine group (difference 1.1±0.33; p = 0.032; Mann-Whitney U-test). The higher puncture failure rate in the lidocaine group (n = 11 v 4) was not significant (p = 0.06; Fisher's exact test). The time required for the intervention was longer in the lidocaine group (138±44 s v 128±44 s; p = 0.019; Mann-Whitney U-test).
  
  
  CONCLUSIONS
  Vapocoolant spray is an alternative to lidocaine infiltration to mitigate discomfort associated with arterial cannulation.
authors: Department of Anesthesia and Intensive Care, University Hospital Giessen - Marburg, Marburg Campus, Marburg, Germany.
authors: Dirk
authors: D
authors: Rüsch
authors: Department of Anesthesia and Intensive Care, University Hospital Giessen - Marburg, Marburg Campus, Marburg, Germany.
authors: Tilo
authors: T
authors: Koch
authors: Department of Anesthesia and Intensive Care, University Hospital Giessen - Marburg, Marburg Campus, Marburg, Germany.
authors: Florian
authors: F
authors: Seel
authors: Department of Anesthesia and Intensive Care, University Hospital Giessen - Marburg, Marburg Campus, Marburg, Germany. Electronic address: eberhart@staff.uni-marburg.de.
authors: Leopold
authors: L
authors: Eberhart
mesh_terms: D000336:Aerosols; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods*; D050785:Cryoanesthesia / Q000379:methods*; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D017534:Radial Artery; D016037:Single-Blind Method
chemical_list: D000336:Aerosols; D000779:Anesthetics, Local; D008012:Lidocaine
keywords: arterial puncture; catheterization; cryoanesthesia; local anesthesia; pain; peripheral