Topical Lidocaine plus Diclofenac as a Local Anesthetic Agent in Central Venous Catheterization; a Randomized Controlled Clinical Trial
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
Introduction: Various methods of analgesia can be used to reduce or prevent procedural pain in emergency department (ED). This study aimed to evaluate the effectiveness of topical lidocaine-diclofenac combination compared to lidocaine-prilocaine combination (Xyla-P) in reduction of the pain during central venous catheter (CVC) insertion.
Methods: In this randomized clinical trial, 100 adult patients requiring CVC insertion in the ED were enrolled. These patients were randomly divided into two groups. The site of CVC insertion was covered with 2 g of topical Xyla-P cream in the first group, and 2 g of topical lidocaine-diclofenac cream in the second group. The primary outcome was the pain during CVC implantation. The secondary outcomes were physician satisfaction and the incidence of side effects.
Results: On the visual analog scale (VAS), the pain score during CVC insertion was significantly lower in the second group (p = 0.027). However, there was no difference in pain scores during lidocaine injection between the two groups (p = 0.386). Also, there was no significant difference in the rate of side effects between the two groups (p = 1.0). The physician’s satisfaction with the first group was significantly lower than the second group (p = 0.042).
Conclusion: Although the CVC insertion pain was significantly lower in patients who received the topical combination of Lidocaine plus Diclofenac, there was no clinically important difference between the two groups and both topical anesthetics were effective and safe in reducing pain intensity. Also, lidocaine-diclofenac combination cream was more cost-effective than Xyla-P cream.
- Anesthetics, Local
- Central Venous Catheters
- Pain Management
How to Cite
Donati A, Damiani E, Adrario E, Romano R, Pelaia P. Pain and discomfort management during central venous catheter insertion. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2014;18(7):417.
Esmailian M, Azizkhani R, Najafi N. Saline flush versus chest x ray in confirmation of central venous catheter placement; a diagnostic accuracy study. Emergency. 2017;5(1):e75.
Samantaray A. Effects of dexmedetomidine on procedural pain and discomfort associated with central venous catheter insertion. Indian journal of anaesthesia. 2014;58(3):281.
Samantaray A, Hanumantha Rao M, Sahu CR. Additional Analgesia for Central Venous Catheter Insertion: A Placebo Controlled Randomized Trial of Dexmedetomidine and Fentanyl. Critical Care Research and Practice. 2016;2016:9062658.
Nataloni S, Carsetti A, Gabbanelli V, Donati A, Adrario E, Pelaia P. A rare case of central venous catheter malpositioning in polytraumatic patient not recognized by chest x-ray. The journal of vascular access. 2013;14(1):97-8.
Veloso C, Cardoso C, Vitorino C. Topical Fixed-Dose Combinations: A Way of Progress for Pain Management? Journal of Pharmaceutical Sciences. 2021.
Heydari F, Khalilian S, Golshani K, Majidinejad S, Masoumi B, Massoumi A. Topical ketamine as a local anesthetic agent in reducing venipuncture pain: A randomized controlled trial. The American Journal of Emergency Medicine. 2021;48:48-53.
Majidi A, Shahhosseini T, Mahmoudi S. Performance of local anesthesia with lidocaine among opium addicts and non-addicts; a case control study. Emergency. 2018;6(1):e35.
Lüllmann B, Leonhardt J, Metzelder M, Hoy L, Gerr H, Linderkamp C, et al. Pain reduction in children during port-à-cath catheter puncture using local anaesthesia with EMLA™. European journal of pediatrics. 2010;169(12):1465-9.
Agarwal A, Dhiraaj S, Kumar A, Singhal V, Singh U. Evaluation of a diclofenac transdermal patch for the attenuation of venous cannulation pain: a prospective, randomised, double‐blind, placebo‐controlled study. Anaesthesia. 2006;61(4):360-2.
Cassuto J, Sinclair R, Bonderovic M. Anti‐inflammatory properties of local anesthetics and their present and potential clinical implications. Acta Anaesthesiologica Scandinavica. 2006;50(3):265-82.
Reśliński A, Dąbrowiecki S, Głowacka K. The impact of diclofenac and ibuprofen on biofilm formation on the surface of polypropylene mesh. Hernia. 2015;19(2):179-85.
Riordan JT, Dupre JM, Cantore-Matyi SA, Kumar-Singh A, Song Y, Zaman S, et al. Alterations in the transcriptome and antibiotic susceptibility of Staphylococcus aureus grown in the presence of diclofenac. Annals of clinical microbiology and antimicrobials. 2011;10(1):1-11.
Liedtke RK. Pharmacological concept for topical synergistic analgesia of peripheral neuromuscular pain. Arzneimittelforschung. 2006;56(02):108-14.
Linares-Gil MJ, Valls J, Hereu-Boher P, Nebot F, De-Ramón B, Diaz-Munió E, et al. Topical analgesia with lidocaine plus diclofenac decreases pain in benign anorectal surgery: randomized, double-blind, and controlled clinical trial. Clinical and translational gastroenterology. 2018;9(11):210.
Fujimoto K, Adachi H, Yamazaki K, Nomura K, Saito A, Matsumoto Y, et al. Comparison of the pain-reducing effects of EMLA cream and of lidocaine tape during arteriovenous fistula puncture in patients undergoing hemodialysis: A multi-center, open-label, randomized crossover trial. PloS one. 2020;15(3):e0230372.
Khalili S, Safavi M, Rezaei R, Bidmeshki M, Shirzad F, Nasiri M. The effectiveness of diclofenac gel and eutectic mixture of local anesthetic cream on vein puncture pain severity with vein catheter in patient undergoing cesarean section: A randomized, double-blind, placebo-controlled trial. International Journal of Applied and Basic Medical Research. 2014;4(Suppl 1):S46.
Deshpande C, Jain V. Comparison between diclofenac transdermal patch vs transdermal emla (eutectic mixture of local anaesthetic) cream for attenuation of pain of venous cannulation. Journal of Anaesthesiology Clinical Pharmacology. 2010;26(2):231-6.
Babaieasl F, Yarandi HN, Saeidzadeh S, Kheradmand M. Comparison of EMLA and Diclofenac on Reduction of Pain and Phlebitis Caused by Peripheral IV Catheter: A Randomized-Controlled Trial Study. Home healthcare now. 2019;37(1):17-22.
Finsen V. Reduced pain when injecting lidocaine. Tidsskrift for Den norske legeforening. 2017;137(9):629-30.
Azizkhani R, Forghani M, Maghami-Mehr A, Masomi B. The effects of injections of warmed bicarbonate-buffered lidocaine as a painkiller for patients with trauma. Journal of Injury and Violence Research. 2015;7(2):87.
Culp Jr WC, Yousaf M, Lowry B, McCowan TC, Culp WC. Pain and efficacy of local anesthetics for central venous access. Local and regional anesthesia. 2008;1:11-5.
Selvi F, Bedel C, Akçimen M. Evaluation of vapocoolant spray effect on pain reduction during digital nerve block: A randomized clinical trial. The American Journal of Emergency Medicine. 2021;50:260-3.
- Abstract Viewed: 365 times
- pdf Downloaded: 142 times