Abstract
Purpose
To compare the efficacy and side effects of transdermal diclofenac patch with eutectic mixture of local anesthetic (EMLA) cream in attenuating venous cannulation pain.
Methods
Adult ASA I or II patients undergoing elective surgery were randomly divided into three groups of 150 each. Group 1 (Control) patients received a placebo patch; Group 2 (EMLA) patients received EMLA cream; Group 3 (Diclofenac) patients received a transdermal diclofenac patch. The patches were applied at the proposed venous cannulation site 60 min prior to cannulation and pain resulting from an 18G cannula was assessed on an ten-point visual analogue scale (VAS). The cannulation site was observed for blanching, erythema, induration and edema for up to 24 hr.
Results
The incidence of venous cannulation pain was 100% in the control group, as compared to 37% and 48% of patients who experienced pain in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups, respectively. The severity of venous cannulation pain [median (VAS) with interquartile ranges] was also higher in the control group: 6 (3) as compared to VAS sores of 0 (1) and 0 (2) in the EMLA (P = 0.001) and diclofenac (P = 0.001) groups. Blanching occurred with greater frequency in the EMLA group compared with the diclofenac (P = 0.001 at six hours) and placebo groups (P = 0.001 at six hours). Erythema, induration and edema were reduced in the diclofenac group compared with the EMLA (P = 0.001 for all comparisons) and placebo groups (P = 0.04 for edema at six hours andP = 0.001 for other comparisons).
Conclusion
Transdermal diclofenac patch and EMLA are equally effective in reducing venous cannulation pain, but signs of erythema, induration and edema are less frequently observed with the transdermal diclofenac patch.
Résumé
Objectif
Comparer l’efficacité et les effets secondaires du diclofenac transdermique au mélange eutectique d’anesthésiants locaux en crème (EMLA®) pour atténuer les douleurs associées au cathétérisme veineux.
Méthode
Des patients adultes ASA I et II devant subir une chirurgie élective ont été randomisés en trois groupes de 150. Un timbre placebo a été donné au groupe 1 (témoin); le groupe 2 (EMLA®) a reçu la crème EMLA®; le groupe 3 a reçu un timbre de diclofenac transdermique. Les timbres ont été appliqués au site prévu de canulation veineuse 60 min avant le cathétérisme, et la douleur provoquée par une canule de 18G a été évaluée sur une échelle visuelle analogue de onze points (EVA). L’apparition de blanchiment, d’érythème, d’induration ou d’œdème de la peau au site de canulation a été surveillée jusqu’à 24 h.
Résultats
L’incidence de douleur associée à la canulation veineuse fut de 100 % dans le groupe témoin, comparée à 37 % et 48 % dans les groupes EMLA® (P = 0,001) et diclofenac (P = 0,001) respectivement. La sévérité de la douleur associée à la canulation veineuse [(EVA) médian avec variations de quartile] fut également plus élevée dans le groupe témoin: 6 (3) sur l’échelle EVA comparé à 0 (1) et 0 (2) dans les groupes EMLA® (P = 0,001) et diclofenac (P = 0,001). L’apparition de blanchiment cutané fut plus fréquente dans le groupe EMLA® comparé aux groupes diclofenac (P = 0,001 à six heures) et placebo (P = 0,001 à six heures). Les érythèmes, indurations et oedèmes furent diminués dans le groupe diclofenac comparé aux groupes EMLA® (P = 0,001 pour toutes les comparaisons) et placebo (P = 0,04 pour l’œdème à six heures et P = 0,001 pour les autres comparaisons).
Conclusion
Le diclofenac transdermique et la crème EMLA® sont tous deux efficaces pour réduire la douleur associée à la ponction veineuse, mais les signes d’érythème, d’induration et d’œdème cutané sont moins fréquents avec le diclofenac transdermique.
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References
Nystrom B, Larsen SO, Dankert J, et al. Bacteraemia in surgical patients with intravenous devices: a European multicentre incidence study. The European Working Party on Control of Hospital Infections. J Hosp Infect 1983; 4: 338–49.
Payne-James JJ, Bray MJ, Kapadia S, Rana SK, McSwiggan D, Silk DB. Topical nonsteroidal antiinflammatory gel for the prevention of peripheral vein thrombophlebitis. A double-blind, randomised, placebo-controlled trial in normal subjects. Anaesthesia 1992; 47: 324–6.
Lal MK, McClelland J, Phillips J, Taub NA, Beattie RM. Comparison of EMLA cream versus placebo in children receiving distraction therapy for venepuncture. Acta Paediatr 2001; 90: 154–9.
Armstrong P, Young C, McKeown D. Ethyl chloride and venepuncture pain: a comparison with intradermal lidocaine. Can J Anaesth 1990; 37: 656–8.
Henderson JM, Spence DG, Komocar LM, Bonn GE, Stenstrom RJ. Administration of nitrous oxide to pediatric patients provides analgesia for venous cannulation. Anesthesiology 1990; 72: 269–71.
Carlson KL, Broome M, Vessey JA. Using distraction to reduce reported pain, fear, and behavioral distress in children and adolescents: a multisite study. J Soc Pediatr Nurs 2000; 5: 75–85.
Usichenko TI, Pavlovic D, Foellner S, Wendt M. Reducing venipuncture pain by a cough trick: a randomized crossover volunteer study. Anesth Analg 2004; 98: 343–5.
Agarwal A, Sinha PK, Tandon M, Dhiraaj S, Singh U. Evaluating the efficacy of the valsalva maneuver on venous cannulation pain: a prospective, randomized study. Anesth Analg 2005; 101: 1230–2.
Gupta D, Agarwal A, Dhiraaj S, et al. An evaluation of efficacy of balloon inflation on venous cannulation pain in children: a prospective, randomized, controlled study. Anesth Analg 2006; 102: 1372–5.
Smith AJ, Eggers KA, Stacey MR. Topical ibuprofen for skin analgesia prior to venepuncture. Anaesthesia 1996; 51: 495–7.
Buckley MM, Benfield P. Eutectic lidocaine/prilocaine cream. A review of the topical anaesthetic/analgesic efficacy of a eutectic mixture of local anaesthetics (EMLA). Drugs 1993; 46: 126–51.
Dutta A, Puri GD, Wig J. Piroxicam gel, compared to EMLA cream is associated with less pain after venous cannulation in volunteers. Can J Anesth 2003; 50: 775–8.
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: 360–2.
Moore RA, Tramer MR, Carroll D, Wiffen PJ, McQuay HJ. Quantitive systematic review of topically applied non-steroidal anti-inflammatory drugs. BMJ 1998; 316: 333–8.
Predel HG, Koll R, Pabst H, et al. Diclofenac patch for topical treatment of acute impact injuries: a randomised, double blind, placebo controlled, multicentre study. Br J Sports Med 2004; 38: 318–23.
Evans JM, McMahon AD, McGilchrist MM, et al. Topical non-steroidal anti-inflammatory drugs and admission to hospital for upper gastrointestinal bleeding and perforation: a record linkage case-control study. BMJ 1995; 311: 22–6.
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Agarwal, A., Gautam, S., Gupta, D. et al. Transdermal diclofenac patchvs eutectic mixture of local anesthetics for venous cannulation pain. Can J Anesth 54, 196–200 (2007). https://doi.org/10.1007/BF03022640
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DOI: https://doi.org/10.1007/BF03022640