Comparison of Two Lidocaine Administration Techniques on Perceived Pain from Bedside Procedures: A Randomized Clinical Trial.
Chest. 2018 Apr 23;:
Authors: Patel BK, Wendlandt BN, Wolfe KS, Patel SB, Doman E, Pohlman AS, Hall JB, Kress JP
BACKGROUND: Lidocaine is used to alleviate procedural pain, but paradoxically increases pain during injection. Pain perception can be modulated by non-noxious stimuli such as temperature or touch according to the gate control theory of pain. We postulated that lidocaine dripped onto the skin prior to injection would cool or touch the skin surface to reduce pain perception from the procedure.
METHODS: We conducted a randomized clinical trial of patients referred to the procedure service from February 2011 thru March 2015. All patients received 1% subcutaneous lidocaine injection. Patients randomized to the Intervention group had ∼1-2ml squirted onto the skin surface prior to subcutaneous lidocaine injection. Patients were blinded to the details of the intervention and were surveyed by a blinded investigator to document the primary outcome, severity of pain from the procedure, using a visual analogue scale (VAS).
RESULTS: Four hundred and eighty-one patients were consented and randomized. There was a significant improvement in the primary outcome of procedural pain (Control 16.6mm±24.8 vs 12.2mm±19.4; p=0.03) with the Intervention group as assessed by VAS score. Pain scores were primarily improved for peripherally inserted central catheters (PICCs) (Control 18.8mm±25.6 vs 12.2mm±18.2; p=0.02) upon subgroup analysis.
CONCLUSION: Bedside procedures are exceedingly common. Data regarding the severity of procedural pain and strategies to mitigate it are important for the informed consent process and patient satisfaction. Overall, pain reported from common bedside procedures is low, but pain can be further reduced with the addition of lidocaine onto the skin surface to modulate pain perception.
PMID: 29698720 [PubMed - as supplied by publisher]