title: Comparative Evaluation of Volatile Anaesthetic Agents for Attenuation of Venous Cannulation Pain: A Prospective, Randomized Controlled Study.
abstract: BACKGROUND
  Topical application of volatile anaesthetic agents has been found to attenuate the response to a mechanical stimulus; however, this effect of volatile anaesthetic on perception of pain during venous cannulation is not known.
  
  
  OBJECTIVE
  To compare the efficacy of topically administered volatile anaesthetic agents for attenuating venous cannulation pain.
  
  
  METHODS
  This prospective, randomized, placebo controlled and double blind study was conducted on 120 patients, aged 20-60years. They were of American Society of Anaesthesiologists (ASA) I or II physical status, of either sex, planned for elective surgeries. These patients were randomized into 4 groups, of 30 each. Equipotent doses of halothane (1ml), isoflurane (1.5ml), sevoflurane (2.7ml) and sterile water (2.5ml; Control) were topically administered on the volar surface of forearm wrapped with cotton and aluminium foil; venous cannulation was performed with 18G intravenous cannula after 30 min. These patients were assessed for the incidence and severity of pain upon venous cannulation {visual analog scale (VAS), 0-100mm; 0 = no pain and 100 = worst imaginable pain}. Data were analysed by one-way ANOVA, Chi-square test and Kruskal-Wallis test. The p<0.05 was considered as significant.
  
  
  RESULTS
  A significant reduction in the incidence of venous cannulation pain was observed in the halothane (79%) group as compared to control (100%; p<0.05), isoflurane (100%; p<0.05) and sevoflurane (100%; p<0.05) groups. The severity of venous cannulation pain as assessed by median (interquartile range, Q1-Q3). VAS scores was reduced in the halothane {10 (10-20); p<0.001}, isoflurane {20 (10-30); p<0.001} and sevoflurane {20 (20-30); p<0.001} groups as compared to the control group {40 (30-40)}; VAS score in the halothane group was significantly less as compared to isoflurane (p<0.05) and sevoflurane (p<0.05) groups.
  
  
  CONCLUSIONS
  Topical application of halothane is most effective in reducing incidence and severity of venous cannulation pain; however, topical application of isoflurane and sevoflurane decreases only the severity of venous cannulation pain.
authors: Senior Consultant, Department of Anaesthesiology, Apollo Hospitals , Bilaspur, Chhattisgarh, India .
authors: Vinit K
authors: VK
authors: Srivastava
authors: Associate Professor, Department of Anaesthesiology, Dr RML Institute of Medical Sciences , Lucknow, Uttar Pradesh, India .
authors: Pravin K
authors: PK
authors: Das
authors: Assistant Professor, Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India .
authors: Sujeet Ks
authors: SK
authors: Gautam
authors: Consultant, Department of Anaesthesiology, Apollo Hospitals , Bilaspur, Chhattisgarh, India .
authors: Parineeta
authors: P
authors: Jaisawal
authors: DNB Student, Department of Anaesthesiology, Apollo Hospitals , Bilaspur, Chhattisgarh, India .
authors: Venkat N
authors: VN
authors: Kadiyala
authors: DNB Student, Department of Anaesthesiology, Apollo Hospitals , Bilaspur, Chhattisgarh, India .
authors: Sonal
authors: S
authors: Rambhad
keywords: Halothane; Isoflurane; Sevoflurane