SUBCUTANEOUS BUFFERED LIDOCAINE FOR INTRAVENOUS CANNULATION - IS THERE A ROLE IN EMERGENCY-MEDICINE

Objective: To prospectively evaluate whether subcutaneous buffered lid ocaine (SQBL) significantly reduces the pain or adversely affects the success rate of IV cannulation (NC) in adult ED patients. Methods: A c onvenience sample of patients greater than or equal to 18 years old re quiring NC in a regional military ED were prospectively randomized to receive SQBL, SQ normal saline with 0.9% benzyl alcohol (SQNS), or no pretreatment (NPTx), prior to IVC with an 18-gauge angiocatheter. SQ i nfiltration was accomplished using a 27-gauge insulin syringe. Investi gators and patients were blinded to SQBL and SQNS in the pretreatment groups. The number of attempts at NC was recorded for each patient. A 100-mm visual analog pain scale (VAPS) was used to record pain scores for both SQ infiltration and NC. Comparisons of the mean numbers of at tempts to achieve NC and of the VAPS scores were accomplished by analy sis of variance followed by Duncan's multiple range test if significan ce was found. Results: A total of 103 patients (SQBL-34, SQNS-30, and NPTx-39) were enrolled between November 15, 1996, and June 13, 1997. T here were no significant differences among the groups in either the me an number of attempts (SQBL = 1.35, 95% CI +/- 0.260; SQNS = 1.13, 95% CI +/- 0.124; and NPTx = 1.28, 95% CI +/- 0.203) (p = 0.367) or the s uccess rate on the first attempt (SQBL = 79.4%, SQNS = 86.7%, NPTx = 7 9.5%) (p = 0.533). The median VAPS score of NC without pretreatment (2 1 mm, 95% CI +/- 7.97) was greater than that for SQBL infiltration alo ne (10 mm, 95% CI +/- 9.11), SQNS infiltration alone (9 mm, 95% CI +/- 7.37), and NC after SQBL (6 mm, 95% CI +/- 9.18) (p < 0.009 for each group). SQNS infiltration had no significant effect on the VAPS score of subsequent IVC (20 mm, 95% CI + 10.5) compared with NC without pret reatment (21 mm). Conclusions: SQBL significantly reduced the pain, wh ile not adversely affecting the success rate, of NC in adult patients in the ED.