BUFFERED LIDOCAINE - ANALGESIA FOR INTRAVENOUS LINE PLACEMENT IN CHILDREN

Objectives. To evaluate the effectiveness of intradermal buffered lido caine as analgesia before intravenous line (IV) placement in children. Methods. This was a randomized clinical trial undertaken in the emerg ency department (ED) of a regional children's hospital. Participants w ere children 8 to 15 years old, seen in the ED and in need of IV lines . They were enrolled by three ED nurses. Participants were randomized to receive either intradermal buffered lidocaine or no analgesia. Befo re placement of the IV line, patients recorded the amount of pain they were in (baseline pain) on a visual analog pain scale. The primary ou tcome measure was amount of pain caused by the initial IV attempt, eve n if that attempt was unsuccessful. This was recorded by the participa nt on a visual analog scale. Demographic characteristics, the number o f attempts to successful placement, and the time required to plate the IV line were also recorded. Differences in pain of initial IV attempt and time to place the IV line were evaluated with the Mann-Whitney U test. Differences in success of IV line placement were evaluated with the chi(2) test. Results. Fifty-nine patients completed the study, Thi rty received buffered lidocaine, and 29 received no analgesia before I V line placement. There was no significant difference between the two groups with regard to baseline pain or demographic characteristics. Th e median level of pain of the initial IV attempt as measured by the vi sual analog scale was 2.3 in the buffered-lidocaine group and 4.4 in t he no-lidocaine group, Thirty-three percent of patients in the lidocai ne group and 28% percent in the no-lidocaine group required more than one IV attempt. The median time to IV line placement was 10 minutes in the lidocaine group and 6 minutes in the no-lidocaine group. Conclusi ons. Use of intradermal buffered lidocaine is an effective way to dimi nish the pain of IV line placement in children 8 to 15 years of age. T here was no difference in IV success rate in this study; however, larg er numbers of patients would be required to detect statistically signi ficant differences. We recommend the routine use of intradermal buffer ed lidocaine for analgesia before IV line placement in older children in all but emergent situations.