Comparison of Analgesic Effect of Local Anesthetic Injection for Pain Relief During Peripheral Venous Insertion in Adult Surgical Patients: A Prospective Observational Study.

IF 1.6 4区 医学 Q2 NURSING Journal of Perianesthesia Nursing Pub Date : 2024-09-18 DOI:10.1016/j.jopan.2024.06.108
Susumu Yoshida, Kiyoyuki W Miyasaka, Rimu Suzuki, Nobuko Fujita, Seiki Abe
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Abstract

Purpose: Intradermal injection of local anesthetic has been reported to have greater analgesic effect for peripheral venous catheter (PVC) insertion than topical application in adult surgical patients. However, the injection of local anesthetic itself is a painful procedure compared to topical application. We compared the analgesic effect of a lidocaine-prilocaine patch with intradermal injection of 2 % lidocaine on pain intensity at the time of analgesia and PVC insertion as assessed by a visual analog scale (VAS) in adult patients.

Design: A prospective observational study.

Methods: After institutional review board (IRB) approval, we studied 70 patients scheduled for surgery and expected to have peripheral venous cannulation in the operating room. Patients who presented in the operating room with a topical anesthetic patch were assigned to the patch group, and patients who presented without a topical anesthetic patch were assigned to the injection group. The injection group received a 2 % lidocaine injection with a 26-gauge (G) needle just before PVC insertion by anesthetists. The patch group received a lidocaine-prilocaine patch on the dorsal hand 1 to 2 hours before the scheduled surgery time by ward nurses. The primary endpoints were pain using the VAS score at the time of PVC insertion and pain associated with the local anesthetic procedure.

Findings: The patch group included 34 patients (21 male, 13 female, age 61 [median], interquartile range [IQR] 45 to 69), and the intradermal injection group included 31 patients (22 male, 9 female, age 60 [median], IQR 52 to 73). All patients analyzed had a 20-G catheter in the dorsal hand. The median VAS score for PVC insertion was 4 in the intradermal injection group (IQR 0 to 14) and 2 in the patch group (IQR 0 to 16) (P = .707). Median VAS scores for the local anesthetic procedure were 16 in the intradermal injection group (IQR 10 to 32) and 0 in the patch group (IQR 0 to 0) (P < .001).

Conclusions: We found no difference in the pain intensity for PVC insertion between topical application of local anesthetic by lidocaine-prilocaine patch and intradermal injection of 2 % lidocaine. VAS scores for anesthetic application were significantly lower in the patch group. The lidocaine-prilocaine patch provided analgesia equivalent to intradermal injection with 2 % lidocaine for PVC but without the pain associated with injection of local anesthetic.

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比较局麻药注射对成人外科手术患者外周静脉置管过程中的镇痛效果:前瞻性观察研究
目的:有报道称,在成年手术患者插入外周静脉导管(PVC)时,皮内注射局麻药比局部应用具有更强的镇痛效果。然而,与局部应用相比,注射局麻药本身是一个痛苦的过程。我们比较了利多卡因-普鲁卡因贴片与皮内注射2%利多卡因对成年患者镇痛时疼痛强度和插入PVC时疼痛强度的影响,以视觉模拟量表(VAS)进行评估:前瞻性观察研究:经机构审查委员会(IRB)批准后,我们对 70 名计划接受手术且预计将在手术室进行外周静脉插管的患者进行了研究。带局部麻醉贴片进入手术室的患者被分配到贴片组,未带局部麻醉贴片进入手术室的患者被分配到注射组。注射组在麻醉师插入 PVC 前用 26 号针头注射 2% 的利多卡因。贴片组在预定手术时间前 1 到 2 小时由病房护士在手背上贴上利多卡因-普鲁卡因贴片。主要终点是插入 PVC 时的 VAS 疼痛评分和与局部麻醉过程相关的疼痛:贴片组包括 34 名患者(21 名男性,13 名女性,年龄[中位数]61 岁,四分位数间距[IQR] 45 至 69),皮内注射组包括 31 名患者(22 名男性,9 名女性,年龄[中位数]60 岁,四分位数间距[IQR] 52 至 73)。所有接受分析的患者的手背都插有一根 20 G 导管。皮内注射组 PVC 插入的中位 VAS 评分为 4(IQR 0 至 14),贴片组为 2(IQR 0 至 16)(P = .707)。皮内注射组在局部麻醉过程中的 VAS 评分中位数为 16(IQR 10 至 32),而贴片组为 0(IQR 0 至 0)(P 结论:P = 0.707):我们发现,使用利多卡因-阿普鲁卡因局部麻醉贴片和皮内注射 2% 利多卡因插入 PVC 时的疼痛强度没有差异。贴片组使用麻醉剂时的 VAS 评分明显较低。利多卡因-阿普鲁卡因贴片的镇痛效果相当于皮内注射2%利多卡因进行PVC,但没有注射局麻药带来的疼痛。
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来源期刊
CiteScore
2.20
自引率
17.60%
发文量
279
审稿时长
90 days
期刊介绍: The Journal of PeriAnesthesia Nursing provides original, peer-reviewed research for a primary audience that includes nurses in perianesthesia settings, including ambulatory surgery, preadmission testing, postanesthesia care (Phases I and II), extended observation, and pain management. The Journal provides a forum for sharing professional knowledge and experience relating to management, ethics, legislation, research, and other aspects of perianesthesia nursing.
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