Yoshida Susumu, Miyasaka Kiyoyuki W, Suzuki Rimu, Fujita Nobuko, Abe Seiki
Department of Anesthesia, St. Luke's International Hospital, Tokyo, Japan.
Department of Anesthesia, St. Luke's International Hospital, Tokyo, Japan.
J Perianesth Nurs. 2025 Jun;40(3):531-534. doi: 10.1016/j.jopan.2024.06.108. Epub 2024 Sep 19.
Intradermal injection of local anesthetic has been reported to have greater analgesic effect for peripheral venous catheter (PVC) insertion than topical application in adult surgical patients. However, the injection of local anesthetic itself is a painful procedure compared to topical application. We compared the analgesic effect of a lidocaine-prilocaine patch with intradermal injection of 2 % lidocaine on pain intensity at the time of analgesia and PVC insertion as assessed by a visual analog scale (VAS) in adult patients.
A prospective observational study.
After institutional review board (IRB) approval, we studied 70 patients scheduled for surgery and expected to have peripheral venous cannulation in the operating room. Patients who presented in the operating room with a topical anesthetic patch were assigned to the patch group, and patients who presented without a topical anesthetic patch were assigned to the injection group. The injection group received a 2 % lidocaine injection with a 26-gauge (G) needle just before PVC insertion by anesthetists. The patch group received a lidocaine-prilocaine patch on the dorsal hand 1 to 2 hours before the scheduled surgery time by ward nurses. The primary endpoints were pain using the VAS score at the time of PVC insertion and pain associated with the local anesthetic procedure.
The patch group included 34 patients (21 male, 13 female, age 61 [median], interquartile range [IQR] 45 to 69), and the intradermal injection group included 31 patients (22 male, 9 female, age 60 [median], IQR 52 to 73). All patients analyzed had a 20-G catheter in the dorsal hand. The median VAS score for PVC insertion was 4 in the intradermal injection group (IQR 0 to 14) and 2 in the patch group (IQR 0 to 16) (P = .707). Median VAS scores for the local anesthetic procedure were 16 in the intradermal injection group (IQR 10 to 32) and 0 in the patch group (IQR 0 to 0) (P < .001).
We found no difference in the pain intensity for PVC insertion between topical application of local anesthetic by lidocaine-prilocaine patch and intradermal injection of 2 % lidocaine. VAS scores for anesthetic application were significantly lower in the patch group. The lidocaine-prilocaine patch provided analgesia equivalent to intradermal injection with 2 % lidocaine for PVC but without the pain associated with injection of local anesthetic.
据报道，对于成年外科手术患者，皮内注射局部麻醉药在外周静脉导管（PVC）插入时的镇痛效果优于局部涂抹。然而，与局部涂抹相比，局部麻醉药的注射本身就是一个痛苦的过程。我们比较了利多卡因-丙胺卡因贴剂与皮内注射2%利多卡因对成年患者镇痛时和PVC插入时疼痛强度的影响，疼痛强度通过视觉模拟量表（VAS）进行评估。
一项前瞻性观察性研究。
经机构审查委员会（IRB）批准后，我们研究了7例计划进行手术且预计在手术室进行外周静脉置管的患者。在手术室使用局部麻醉药贴剂的患者被分配到贴剂组，未使用局部麻醉药贴剂的患者被分配到注射组。注射组在麻醉师插入PVC之前，用26号（G）针头注射2%利多卡因。贴剂组在预定手术时间前1至2小时，由病房护士在患者手背上贴一张利多卡因-丙胺卡因贴剂。主要终点是PVC插入时使用VAS评分的疼痛情况以及与局部麻醉操作相关的疼痛。
贴剂组包括34例患者（男21例，女13例，年龄中位数61岁，四分位间距[IQR]为45至69岁），皮内注射组包括31例患者（男22例，女9例，年龄中位数60岁，IQR为52至73岁）。所有接受分析的患者在手背上都插入了一根20-G导管。皮内注射组PVC插入时的VAS评分中位数为4（IQR为0至14），贴剂组为2（IQR为0至16）（P = 0.707）。局部麻醉操作的VAS评分中位数在皮内注射组为16（IQR为10至32），贴剂组为0（IQR为0至0）（P < 0.001）。
我们发现，利多卡因-丙胺卡因贴剂局部涂抹与皮内注射2%利多卡因在PVC插入时的疼痛强度上没有差异。贴剂组麻醉应用的VAS评分显著更低。利多卡因-丙胺卡因贴剂在PVC插入时提供了与皮内注射2%利多卡因相当的镇痛效果，但没有与局部麻醉药注射相关的疼痛。
