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Fig. 1
Flow diagram of patient enrollment, allocation, follow-up, and analysis.
Fig. 2
Subject pain VNRS scores associated with venipuncture. The horizontal axis separates data for each individual subject. The vertical axis represents the patient-reported pain VNRS score (0-10). Each pair of bars represents data for a single patient. The black bars represent pain associated with venipuncture after administration of placebo. The gray bars represent pain associated with venipuncture after administration of sterile water.
Fig. 3
Boxplot of subject reported ordinal pain scale scores from 1 to 10 associated with venous catheterization. The midlines represent the medians. The bottom and top box edges represent the 25th and 75th percentiles, respectively. The bottom and top “whiskers” represent the minimum and maximum values, respectively. Subjects reported significantly lower pain with venous catheterization after topical ethyl chloride than topical placebo (P = .001 by Wilcoxon signed rank testing).
Abstract
Objective
To compare pain associated with venous catheterization after administration of topical ethyl chloride vs placebo among emergency department health care providers.
Methods
We conducted a randomized, double-blind, placebo-controlled, crossover trial among a convenience sample of health care provider volunteers in a tertiary care urban emergency department. We randomly allocated subjects to initial treatment (ethyl chloride vs sterile water aerosol spray) and catheterization site (left or right antecubital fossa). After venous catheterization placement and discontinuation, subjects underwent a 5-minute washout period. All subjects then underwent venous catheterization in the contralateral antecubital fossa after administration of the alternative agent. We measured all outcomes after discontinuation of the second catheter. The primary outcome was difference in pain verbal numeric rating scale score (0-10) between the 2 agents. Secondary outcomes included preferred agent (binary) and future willingness to use agent on patients (5-point Likert scale).
Results
Thirty-eight health care providers were recruited; all completed the study. Median pain verbal numeric rating scale scores were 4 (interquartile range, 2-5) for placebo vs 2 (1-4) for ethyl chloride. The effect size for pain reduction with ethyl chloride compared with placebo was 2 (95% confidence interval, 0.5-2; P = .001). Most subjects (68.4%) preferred ethyl chloride to placebo. Five-point Likert scale scores measuring willingness to use preferred product on future patients were higher by 2 (95% confidence interval, 1-3) among subjects preferring ethyl chloride vs placebo.
Conclusions
We found that topical ethyl chloride yields a greater reduction in pain associated with venous catheterization compared with topical placebo.
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☆Funding: None.
☆☆Disclaimers: The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army and Department of Defense, or the US Government.
