Pain and efficacy of local anesthetics for central venous access

Original Research

(3206) Views  (1027) Full article downloads

Authors: William C Culp Jr, Mohammed Yousaf, Benjamin Lowry, Timothy C McCowan, William C Culp

Published Date November 2008 Volume 2008:1 Pages 11 - 15

DOI: http://dx.doi.org/10.2147/LRA.S4337

William C Culp Jr¹, Mohammed Yousaf², Benjamin Lowry¹, Timothy C McCowan³, William C Culp²

¹Division of Cardiothoracic Anesthesiology, Scott and White Hospital, The Texas A&M University College of Medicine, Temple, TX, USA; ²Division of Interventional Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA; ³Department of Radiology, University of Mississippi Medical Center, Jackson, MS, USA

Purpose: To compare pain during injection and efficacy of analgesia of local anesthetics during central venous line placement.

Methods: Sixty-two patients were studied in a randomized, double-blinded prospective fashion. Patients received 1% lidocaine (L), buffered 1% lidocaine (LB), or 2% chloroprocaine (CP) injected around the internal jugular vein for procedural analgesia for central venous access. Patients reported pain via a standard linear visual analog scale, with 0 representing no pain and 10 being the worst pain imaginable.

Results: Overall patient perception of pain was better with CP and L than LB with mean scores of CP 2.4, L 2.6, LB 4.2. Pain with injection mean scores were CP 2.1, L 2.5, LB 3.2. Pain with catheter placement scores were CP 2.5, L 1.7, LB 3.4. Operator assessment of overall pain values were CP 1.9, L 2.2, LB 3.4. LB consistently scored the worst, though compared with CP, this only reached statistical significance in overall patient pain and pain at catheter insertion compared with L.

Conclusion: Though chloroprocaine scored better than lidocaine in 3 of 4 parameters, this trend did not achieve statistical significance. Adding sodium bicarbonate to lidocaine isn’t justified in routine practice, nor is routine replacement of lidocaine with chloroprocaine.

Keywords: local anesthesia, analgesia, central venous access, lidocaine, chloroprocaine