Lidocaine, Dripped on the Skin, Attenuates Procedural Pain

Patricia Kritek, MD reviewing Patel BK et al. Chest 2018 Oct

Bedside procedures were less painful when lidocaine was dripped on the skin before subcutaneous lidocaine injections.

We commonly use lidocaine to numb the skin and soft tissue prior to performing bedside procedures, but its administration causes an uncomfortable burning sensation. Previous research has shown that nerve fibers transmit pain sensation more slowly when they are "occupied" with other stimuli, such as vibration or cold. With the hypothesis that a cool, wet stimulus on the skin would attenuate pain associated with lidocaine injections and the bedside procedures that followed, investigators randomized 481 patients at a single center in Chicago to receive preprocedural subcutaneous injection of 1% lidocaine alone or to receive1 to 2 mL of 1% lidocaine dripped on the skin prior to subcutaneous injection of 1% lidocaine. Most of the procedures were peripherally inserted central catheter (PICC) placements, paracenteses, thoracenteses, lumbar punctures, or central line placements.

PICC patients who received dripped lidocaine prior to injections reported significantly less procedural pain on a visual analog scale (VAS) than did usual-care patients. Differences were not significant for other procedures.

COMMENT

We often minimize the discomfort of lidocaine injections with phrases like "just a little bee sting," but patients often find this to be the worst part of their procedures. Although the difference in scores on the VAS was less than what is thought to be clinically significant, I am intrigued. If these results could be replicated in other proceduralists' hands, incorporating this low-cost, low-risk step to improve patient comfort would make sense.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Patricia Kritek, MD at time of publication

Speaker's Bureau	American College of Chest Physicians (Critical Care Board Review Course)
Editorial boards	American Journal of Respiratory and Critical Care Medicine
Leadership positions in professional societies	American Thoracic Society (Chair of the Nominating Committee, Section on Medical Education)

CITATION(S):

Patel BK et al. Comparison of two lidocaine administration techniques on perceived pain from bedside procedures: A randomized clinical trial. Chest 2018 Oct; 154:773. (https://doi.org/10.1016/j.chest.2018.04.018)

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 2224-0654
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Dermatología en Costa Rica

Wednesday, November 28, 2018