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Topical analgesia for pain reduction in arterial puncture
  1. Debbie Dawson, Clinical Research Nurse,
  2. Kerstin Hogg, Clinical Research Fellow

    Abstract

    A short cut review was carried out to establish whether topical local anaesthetic reduces the pain of arterial puncture. 431 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Debbie Dawson, Clinical Research NurseChecked by Kerstin Hogg, Clinical Research Fellow

    Clinical scenario

    A 56 year old man presents to the emergency department with a 2 day history of pleuritic chest pain and shortness of breath. Pulse oximetry reveals oxygen saturations of 92%, although he does not appear to be acutely short of breath. The patient has had routine blood samples sent to the laboratory but is hesitant to agree to any other blood tests. You wonder therefore, if prior to taking an arterial blood gas sample, application of a topical local anesthetic, would reduce pain and discomfort.

    Three part question

    In [patients who require non-urgent arterial blood gas analysis] does [topical anesthetic] reduce [pain and discomfort]?

    Search strategy

    Medline 1966-12/04 using the OVID interface. [(exp lidocaine OR lidocaine.mp OR exp topical, administration OR exp anesthetics, local OR exp anesthesia, local OR emla.mp OR ametop.mp OR tetracaine OR lignocaine.mp OR prilocaine OR amethocaine.mp) AND (exp arterial puncture.mp OR exp blood gas analysis OR exp blood specimen collection OR arterial blood.mp) NOT (BestBETs paediatric filter)] LIMIT to English language AND human.

    Search outcome

    Altogether 431 papers were identified, of which 429 were found not to answer the question directly, the remaining two papers were found to be relevant.

    Comment(s)

    Previous studies looking at the use of EMLA in pain reduction with venepuncture have highlighted that an application time of 60–90 minutes is necessary for adequate anaesthesia; the manufacturers of tetracaine recommend 45 mins application prior to venepuncture. It may be necessary that longer application times are needed for deeper structures.

    CLINICAL BOTTOM LINE

    The papers found in this search provide little evidence for the effectiveness of topical analgesia in reducing the pain and discomfort of arterial puncture. Further studies with longer application times would be useful.

    Report by Debbie Dawson, Clinical Research NurseChecked by Kerstin Hogg, Clinical Research Fellow

    References

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