Intradermal and Subcutaneous Lignocaine for Arterial Blood Gas Sampling: A Randomized Controlled Trial

Swanevelder Charlene, Prasad Lila, Chen Kevin YY, Zeng Irene, Corna Nicola, Nguyen Anh, Wong Conroy
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Abstract

Introduction: The use of local anesthesia (LA) prior to arterial blood gas sampling is recommended but is not widely used. We tested the hypothesis that intradermal administration of local anesthesia would be as effective as subcutaneous administration in reducing pain from arterial blood gas sampling. Aims: The primary aim of this study was to evaluate the effect of intradermal and subcutaneous lignocaine on patient-perceived pain during arterial blood gas sampling. The secondary aims were to evaluate if different routes of LA administration had an impact on the difficulty and complications of ABG sampling. Methods: We undertook a randomized, single-blind, placebo-controlled trial in New Zealand. We enrolled patients attending a nurse-led outpatient oxygen clinic who were 18 to 90 years of age and who had an oxygen saturation of 93% or less at rest. Patients were randomly assigned to receive intradermal 1% lignocaine, subcutaneous 1% lignocaine, or subcutaneous normal saline. Patients and nurse assessors were blinded to the treatment allocation. The primary endpoint was a patient-assessed pain score using a graphic rating scale (0-10). Results: 135 patients were randomized (54 patients in the intradermal lignocaine group, 54 patients in the subcutaneous lignocaine group, and 27 in the subcutaneous saline group). The mean patient-assessed pain score for the intradermal lignocaine group was 1.8 (+/- 1.1), which was a relative reduction of 47% (95% C.I. 31%-59%, p < 0.0001) from the mean patient-assessed pain score of 3.4 (+/- 1.1) for the subcutaneous saline group. The mean patient-assessed pain score for the subcutaneous lignocaine group was 2.1 (+/- 1.1), which was also a significant relative reduction of 36% (95% C.I. 17%-51%, p = 0.0001) compared to the subcutaneous saline group. Intradermal lignocaine reduced pain more than subcutaneous lignocaine, with a relative pain reduction difference of 20% (95% CI -4%-49%, p = 0.05). Bruising was more frequent in the subcutaneous lignocaine group (9.3%) than in the intradermal (0%) and saline groups (0%). Conclusion: Intradermal lignocaine is at least as effective as subcutaneous lignocaine for reducing patient-perceived pain from arterial blood gas sampling and results in less bruising.
皮内和皮下利格诺卡因用于动脉血气采样:随机对照试验
导言:建议在动脉血气采样前使用局部麻醉(LA),但这种方法并未广泛使用。我们测试了一个假设,即在减轻动脉血气采样疼痛方面,皮内局部麻醉与皮下局部麻醉同样有效。目的:本研究的主要目的是评估皮内和皮下注射木质素卡因对动脉血气采样过程中患者疼痛感的影响。次要目的是评估不同的 LA 给药途径是否会影响 ABG 采样的难度和并发症。方法:我们在新西兰进行了一项随机、单盲、安慰剂对照试验。我们招募了 18 至 90 岁、静息时血氧饱和度为 93% 或更低的氧气门诊患者。患者被随机分配到皮内注射1%木质素卡因、皮下注射1%木质素卡因或皮下注射生理盐水。患者和护士评估员对治疗分配均为盲法。主要终点是患者使用图形评分量表(0-10)对疼痛进行评估。结果135名患者接受了随机治疗(皮内木质素组54人,皮下注射木质素组54人,皮下注射生理盐水组27人)。皮内木质素组患者的平均疼痛评分为 1.8 (+/- 1.1),与皮下注射生理盐水组患者的平均疼痛评分 3.4 (+/- 1.1)相比,相对减少了 47% (95% C.I. 31%-59%, p < 0.0001)。皮下注射木质素组患者评估的平均疼痛评分为 2.1 (+/- 1.1),与皮下注射生理盐水组相比也显著降低了 36% (95% C.I. 17%-51%, p = 0.0001)。皮内注射木质素比皮下注射木质素更能减轻疼痛,疼痛减轻的相对差异为 20% (95% CI -4%-49%, p = 0.05)。皮下注射木质素组(9.3%)比皮内注射(0%)和生理盐水组(0%)更容易出现瘀伤。结论在减轻动脉血气采样时患者的疼痛感方面,皮内木质素卡因的效果至少与皮下木质素卡因相同,而且瘀伤较少。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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