Intravenous catheter insertion pain: What is the best approach?

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“Anesthetics used to decrease pain during peripheral intravenous catheter insertion have been studied with equivocal results. This meta-analysis determined if lidocaine or bacteriostatic normal saline (BaNS) is more effective in reducing pain associated with peripheral intravenous catheter cannulation in adults.” Oman et al (2014).

Reference:

Oman, K.S., Fink, R., Kleiner, C., Makic, M.B., Wenger, B., Hoffecker, L., Mancuso, M., Schmiege, S. and Cook, P. (2014) Intradermal lidocaine or bacteriostatic normal saline to decrease pain before intravenous catheter insertion: a meta-analysis. Journal of Perianesthesia Nursing. 29(5), p.367-76.

Abstract:

PURPOSE: Anesthetics used to decrease pain during peripheral intravenous catheter insertion have been studied with equivocal results. This meta-analysis determined if lidocaine or bacteriostatic normal saline (BaNS) is more effective in reducing pain associated with peripheral intravenous catheter cannulation in adults.

METHODS: PubMed, EMBASE, CINAHL, ProQuest Dissertation and Theses, and Web of Science databases were queried. Thirteen randomized controlled trials were analyzed.

RESULTS: Mean sample was 119.9 (±82.0); combined N was 1,559. Mean effect size was z = 0.46 (confidence interval = 0.24-0.68) indicating lidocaine was more effective than BaNS in providing pain relief (P < .001).

CONCLUSION: Cost-benefit issues and lidocaine drug shortages must be considered when making definitive practice recommendations.

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