Local Anesthetics for Pain Reduction Prior to IV Line Placement
Condition: Pain; Local Anesthesia for Peripheral Intravenous Catheterization
Intervention: Lidocaine; Buffered Lidocaine; Bacteriostatic Normal Saline
Intervention description: The medication will be administered immediately prior to receiving peripheral IV catheter placement; The medication will be administered immediately prior to receiving peripheral IV catheter placement; The medication will be administered immediately prior to receiving peripheral IV catheter placement
Intervention MeSH terms: Lidocaine
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Enrollment: 150.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: Accepts Healthy Volunteers

Summary:

      The purpose of this study is to compare the pain level felt by patients when receiving
      placement of a peripheral intravenous catheter (IV line) following the administration of a
      local anesthetic. The local anesthetics tested will be lidocaine, buffered lidocaine, and
      bacteriostatic normal saline. Lidocaine is commonly used as a premedication for reducing the
      pain upon insertion of peripheral IV lines. However, due to its acidic nature, the lidocaine
      itself may cause pain upon administration. To help counter this discomfort, pharmacies can
      "buffer" the lidocaine using sodium bicarbonate, which increases the pH to a neutral value,
      resulting in less pain. Bacteriostatic normal saline has also been used for local anesthesia
      with peripheral IV placement, particularly in patients with a lidocaine allergy, as it
      contains benzyl alcohol which acts as a local anesthetic.

      There are minimal reports from the literature that directly compare patient reported pain of
      all three agents to one another, although studies do exist that have compared buffered
      lidocaine versus lidocaine and buffered lidocaine versus bacteriostatic normal saline. To
      address this comparison gap, the following research questions need to be asked: which
      anesthetic agent is the superior premedication for reducing the amount of pain upon
      administration of the local anesthetic itself and for the pain associated with the peripheral
      insertion of the catheter? The hypothesis of the investigators is that there is not a
      significant difference in the degree of pain scales between the anesthetic agents to justify
      the pharmacoeconomic costs associated with compounding buffered lidocaine.

      The primary outcome measured in this study will be the level of pain reported by the patient
      upon administration of the local anesthetic and upon insertion of the peripheral intravenous
      catheter. A secondary outcome includes a pharmacoeconomic analysis that will look
      specifically at the cost-savings of using one agent over the other and will take into account
      the daily time allocated to pharmacy technicians and pharmacists for compounding and
      verifying buffered lidocaine.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Males or females > 18 y.o.

          -  Ability to speak, read, an/or understand English

          -  Ability to communicate a level of pain via the specified pain scale

          -  A written order exists for an intravenous peripheral catheter insertion for the
             patient

        Exclusion Criteria:

          -  Lidocaine allergy

          -  Buffered lidocaine allergy

          -  Benzyl alcohol allergy

          -  Non-English speaking

          -  Non-responsive or unable to understand or report pain score (ex. intubated in the ICU)

          -  Inability to place catheter