Painless intravenous catheterization by intradermal jet injection of lidocaine: A randomized trial

Study Objective: To compare efficacy and cost of lidocaine cutaneous anesth esia by two jet injectors to routine needle infiltration for pain relief of intravenous in? catheterization, hypothesizing that jet injection of lidoc aine is less painful than ifs needle infiltration. Design: Randomized, prospective, controlled trial. Setting: University hospital outpatient surgical unit. Participants: 75 surgical patients ASA. I and II. Interventions: Three groups of 25 patients each were given intradermal lido caine anesthesia via conventional 25-gauge needle/syringe; by MedEJet or Bi ojector jet injector prior to IV catheterization with an 18-gauge Jelco cat heter. Measurements and Main Results: Visual analogue pain scores (VAS) (0 = no pa in, 10 = intolerable pain) and subjective pain intensity scores (PIS) (0 = not painful, 4 = intolerable pain) at lidocaine application and at IV cathe terization, were recorded. Cost assessment of each method was made At local anesthetic application, no pain by proportion of VAS = 0 with MedEJet: 25/ 25 (confidence interval [CI]: 0.868,0.9991 and Biojector: 24/25 (CI 0.804 0 .991) was noted but 22 of 25 patients ex;experienced lain with needle admin istration: (with CIS = 0;3/25 [CI: 0.044 0.302]) (posterior probability [PP ] > 0.999). The corresponding VAS scores (means +/- SD) were 0.00 +/- 0.00, 0.04 +/- 0.20 and 2.4 +/- 2.23 (p < 0.001). No pain by proportion of PIS = 0 with MedEJet: 25/25 (CI: 0.868 0.999 and Biojector: 23/25 0.749, 0.976) was noted but pain in 20/25 was felt with the needle: 5/25 (CI: 0.090, 0.39 4) (PP > 0.999). The corresponding PIS scores were 0.00 +/- 0.00, 0.16 +/- 0.55, and 1.24 +/- 1.00 (p < 0.001). At IV catheterization no pain by propo rtion of VAS = 0 with MedEJet: 22/25 (CI: 0.698, 0.956) or Biojector: 21/25 (CI: 0. 651, 0.934) was noted; but pain in 19/25 with needle administratio n was experienced: 6/25 (CI: 0.116, 0.436) (PP > 0.999). The corresponding scores were 0.12 +/- 0.33, 0.44 +/- 0.20 and 1.64 +/- 1.50 (p < 0.001). No pain by proportion of PIS = 0 with MedEJet: 24/25 (CI: 0.804, 0.991) or Bio jector: 24/25 (CI. 0.804, 0.991) was noted, but pain was apparent in 12/25 with needle administration: 13/25 (CI: 0.334, 0. 701) (PP > 0.999). The cor responding scores were 0.00 +/- 0.00, 0.00 +/- 0.00, and 0. 76 +/- 0.88. (p < 0.001). Cost per application: MedEJet = $0.13; needle/string = $0.50; Bi ojector = $0.94. Conclusions:,Almost completely painless IV catheterization was carried out by jet injection of lidocaine, but needle infiltration produced discomfort or pain and did not significantly reduce discomfort or pain at the IV needl e insertion. (C) 1999 by Elsevier Science Inc.