Chest
Volume 110, Issue 6, December 1996, Pages 1443-1445
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Clinical Investigations: Pulmonary Lab
Pain During Arterial Puncture

https://doi.org/10.1378/chest.110.6.1443Get rights and content

Study objective

To quantify the level of pain reported by patients during arterial puncture with or without local anesthesia, and to compare the results with levels reported for venous puncture.

Design

Double-blind study of puncture with and without local anesthesia.

Setting

Pulmonary function laboratory, department of pneumology.

Patients

We studied 270 consecutive patients undergoing arterial puncture divided into two groups. In group A (n=210), we assessed level of pain with and without local anesthesia and with placebo. In group B (n=60), we compared pain of arterial and venous puncture.

Interventions

The arterial puncture was performed in the radial artery; venous puncture was in the median basilic vein.

Measurements and results

The pain was quantified on a visual analog scale (10 cm). Mean level of pain for all arterial punctures without anesthesia or placebo was slight to moderate (3.01 ± 1.94 cm). Subcutaneous anesthetic infiltration before arterial puncture significantly reduced pain by more than 50%, to 1.50±1.54 cm, a level that was significantly lower than the pain level reported after conventional venous puncture (1.80±1.10 cm). The pain reported by patients who received no anesthesia was not significantly different (p=0.45) from that perceived by those who received subcutaneous infiltration of sahne solution (placebo).

Conclusions

Arterial puncture with prior infiltration of local anesthetic is the least painful procedure among those studied. Use of local anesthesia is indicated whenever conventional arterial puncture is required.

Section snippets

Materials and Methods

We conducted a prospective double-blind study of 270 consecutive patients (187 men and 83 women; age, 60±12 years) undergoing lung function tests who required measurement of arterial blood gases. The study, approved by the hospital ethics committee, required that we describe the procedure carefully to all patients, but with no reference to pain that might be experienced. Two main groups were formed. Group A (n=210; 139 men and 71 women, age, 61±12 years) was formed to study pain of arterial

Results

Mean magnitude of pain reported on the visual analog scale for all arterial punctures carried out without either local anesthesia or placebo was 3.01±1.94 cm. After local anesthesia (subgroups A2 and B2), the mean levels of pain for arterial and venous punctures were 1.50±1.54 cm and 1.38±1.18 cm, respectively. Mean magnitude of pain produced by arterial or venous puncture and range of pain in each subgroup are shown in Table 1. We found significant differences between subgroups A1, A3, and B1

Discussion

To our knowledge, this is the first systematic study to show a relation between the magnitude of pain experienced by the patient and the use or not of local anesthesia before the procedure. The intensity of pain produced by direct arterial puncture, with no prior local anesthesia, ranged from slight to moderate in our subjects. Local anesthesia with mepivacaine before the procedure, however, produced a significant reduction in pain, which became even less than that elicited by conventional

References (13)

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Supported by Grant SEPAR-1994

revision accepted July 5.

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