JRSM > Volume 98, Number 6 > Pp. 292

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Letters

The pain of venous cannulation

Michelle Petrou

2 Langside Crescent, London N14 7DR, UK

E-mail: michellepetrou{at}doctors.org.uk

Dr Sado and Dr Deakin (April 2005 JRSM¹) refer to some of the practical reasons why ward doctors are less likely than anaesthetists to use local anaesthesia for vein cannulation. One of them is access to lidocaine. On an eight-hour shift a ward doctor might have to insert up to twenty cannulas; and, if on each occasion the lidocaine has to be produced from a locked cupboard by a nurse, time does not permit. However, time is not the issue here. I do not accept Sado and Deakin's conclusion that patients are suffering 'more pain than necessary'. Assessing the effect of local anaesthesia for vein cannulation, Rohm et al.² in a recent study, found clear benefits for cannulae of 16G or greater but no advantages for 18G (green) and 20G (pink). These smaller cannulae are the ones used most often on the ward. If a 14G cannula is needed, this will probably be an emergency where local anaesthesia would unduly delay treatment. The arguments of Sado and Deakin are hazardous because they could be used unfairly in medicolegal cases. I see no argument for use of local anaesthesia in routine ward cannulation.

REFERENCES

1. Sado DM, Deakin CD. Local anaesthesia for venous cannulation and arterial blood gas sampling: are doctors using it? J R Soc Med 2005;98:158 -60[Abstract/Free Full Text]

2. Rohm KD, Schollhorn TA, Gwosdek MJ, Piper SN, Maleck WH, Boldt J. Do we necessarily need local anaesthetics for venous cannulation? A comparison of different cannula sizes. Eur J Anaesthesiol2004; 21:214 -16[Medline]

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This Article Full Text (PDF) Send a Quick Comment Alert me when this article is cited Alert me when Quick Comments are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Petrou, M. Search for Related Content PubMed PubMed Citation Social Bookmarking                      What's this?