Buffered Lidocaine: Analgesia for Intravenous Line Placement in Children

¹ Departments of Pediatrics, Epidemiology, University of Washington, Children's Hospital and Medical Center, Seattle
² Department of Pediatrics, University of Washington, Children's Hospital and Medical Center, Seattle
³ Children's Hospital and Medical Center, Seattle
⁴ Department of Epidemiology, University of Washington, Seattle

Objectives. To evaluate the effectiveness of intradermal buffered lidocaine as analgesia before intravenous line (IV) placement in children.

Methods. This was a randomized clinical trial undertaken in the emergency department (ED) of a regional children's hospital. Participants were children 8 to 15 years old, seen in the ED and in need of IV lines. They were enrolled by three ED nurses. Participants were randomized to receive either intradermal buffered lidocaine or no analgesia. Before placement of the IV line, patients recorded the amount of pain they were in (baseline pain) on a visual analog pain scale. The primary outcome measure was amount of pain caused by the initial IV attempt, even if that attempt was unsuccessful. This was recorded by the participant on a visual analog scale. Demographic characteristics, the number of attempts to successful placement, and the time required to place the IV line were also recorded. Differences in pain of initial IV attempt and time to place the IV line were evaluated with the Mann-Whitney U test. Differences in success of IV line placement were evaluated with the ² test.

Results. Fifty-nine patients completed the study. Thirty received buffered lidocaine, and 29 received no analgesia before IV line placement. There was no significant difference between the two groups with regard to baseline pain or demographic characteristics. The median level of pain of the initial IV attempt as measured by the visual analog scale was 2.3 in the buffered-lidocaine group and 4.4 in the no-lidocaine group. Thirty-three percent of patients in the lidocaine group and 28% percent in the no-lidocaine group required more than one IV attempt. The median time to IV line placement was 10 minutes in the lidocaine group and 6 minutes in the no-lidocaine group.

Conclusions. Use of intradermal buffered lidocaine is an effective way to diminish the pain of IV line placement in children 8 to 15 years of age. There was no difference in IV success rate in this study; however, larger numbers of patients would be required to detect statistically significant differences. We recommend the routine use of intradermal buffered lidocaine for analgesia before IV line placement in older children in all but emergent situations.

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