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Is the pain of intravenous catheter insertion associated with hemodynamic changes?

Long Beach, California, USA

To the Editor:

Inserting an intravenous (iv) catheter may cause pain which may increase heart rate (HR) or blood pressure (BP). Lidocaine is often used to prevent pain before iv insertion. However, bacteriostatic normal saline containing benzyl alcohol as a preservative (NS-BA) may be as effective as lidocaine and cause less pain on injection.^1–3

We electively studied 60 adult patients. Patients randomly received, in a double-blind fashion, either NS-BA or lidocaine 1% via a 25g needle, or no drug, before inserting an 18g iv catheter. We measured HR and BP at one minute intervals for five minutes before and five minutes after iv catheter insertion. We measured pain scores at the time of drug injection and iv catheter insertion.

There were no differences among the three groups in HR or BP. Mean arterial BP and systolic BP were higher in the minute just before iv catheter insertion than five minutes after iv insertion in all groups (P < 0.0003). Heart rate was higher five minutes before iv catheter insertion, than three or four minutes after iv catheter insertion in all groups (P < 0.000001).

There was no difference in pain on injection between NS-BA and lidocaine. There was no difference in the pain of iv catheter insertion between NS-BA and lidocaine. Iv catheter insertion without local anesthesia was more painful than iv catheter insertion without any drug (P < 0.000001). There was no correlation between verbal pain rating and HR or BP. The pain of iv catheter insertion does not increase HR or BP.

References

1 Nuttall GA, Barnett MR, Smitt RL II, Blue TK, Clark KR, Payton BW. Establishing intravenous access: a study of local anesthetic efficacy. Anesth Analg 1993; 77: 950–3.[Abstract/Free Full Text]

2 Wightman MA, Vaughan RW. Comparison of compounds used for intradermal anesthesia. Anesthesiology 1976; 45: 687–9.[Medline]

3 McNelis KA. Intradermal bacteriostatic 0.9% sodium chloride containing the preservative benzyl alcohol compared with intradermal lidocaine hydrochloride 1% for attenuation of intravenous cannulation pain. AANA J 1998; 66: 583–5.[Medline]

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