Article Text

Local anaesthetic and arterial puncture
1. Damian Bates,
2. Peter Cutting
1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

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Report by Damian Bates; Specialist RegistrarChecked by Peter CuttingSpecialist Registrar

Clinical scenario

A 67 year old man attends with increasing shortness of breath. He is known to have obstructive airways disease. You want to perform arterial puncture for blood gas measurement. He tells you that last time it was very painful. You wonder if an injection of local anaesthetic would help?

Three part question

In [a patient requiring blood gases or arterial puncture] does [an injection of local anaesthetic] [reduce pain without affecting success]?

Search strategy

Medline 1966–07/2001 using the Ovid interface. [{exp blood gas analysis OR abg.mp OR arterial blood gas$.mp OR blood gas$.mp} OR ({exp arteries OR artery.mp OR arterial.mp AND {exp punctures OR puncture$.mp OR exp catheterisation OR cannulation.mp OR cannula.mp}) AND {exp anesthesia, local OR anesthetics, local OR local anesthesi$.mp OR local anaesthesi$.mp} AND {exp pain OR pain$.mp}] LIMIT to human AND english.

Search outcome

Altogether 88 papers were identified of which three were relevant. These three papers are shown in table 3.

Table 3

Lightowler and Elliott surveyed junior doctors prior to their study and found that 84% never used local anaesthetic before arterial puncture citing that it made the procedure both more difficult and more painful. Dar et al cite two papers that showed delay in presentation to be an important contributor to deaths from asthma and suggest that a previous painful experience could lead to such a delay.

Clinical bottom line

Local anaesthetic infiltration prior to arterial puncture significantly reduces the pain of the procedure without affecting success rates.

Report by Damian Bates; Specialist RegistrarChecked by Peter CuttingSpecialist Registrar

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