Response to Article on Topical Anesthesia☆

I recently read the article entitled “The Use of Topical Anesthesia During Intravenous Catheter Insertion in Adults: A Comparison of Pain Scores Using LMX-4 Versus Placebo” in the July 2009 issue of the Journal.1

I am currently a year away from completing my bachelor's degree in nursing, and in my clinical experiences I have encountered many issues regarding pain and how it is managed for each patient. Every patient I have encountered has had a different threshold for pain and has been treated according to his or her pain rating, obtained with use of the 1-to-10 scale. In my clinical experiences I have never encountered an intervention where a topical analgesic was used prior to insertion of an intravenous catheter. The first time I heard of using this intervention with peripheral intravenous catheter (PIV) insertion was in this research article, which sparked an interest for improving my nursing practice now and in the future.

The study by Valdovinos et al1 found that the use of a topical analgesic, specifically LMX-4, does lower a patient's pain rating compared with placebo. The catheter was removed immediately and the pain level was assessed. Results showed that pain was rated lower on the side with the applied topical analgesic.

Pain management is one of nurses' top priorities requiring intervention, and it has been shown that proper preparation will result in less discomfort. Although the intervention described in this article is not seen often in practice, it is very encouraging that the researchers took time to study the comfort level of patients rather than merely trying to finish a job. I completely agree with this study, as it shows evidence-based practice in patient care.

From personal experience, I know that receiving a PIV can be very stressful even before insertion occurs. Anxiety can build and the anticipation of pain makes the experience even less memorable. Applying a topical analgesic not only reduces the pain level but also allows acts as a diversion. It provides comfort in that the patient knows the procedure will result in less pain, allowing for relaxation and a decrease in anxiety levels. Although the study was done with healthy patients, the study provides a baseline of what to expect if this practice becomes protocol or a standard.

A study by Halm2 yielded similar results, with a reduction in pain through the use of various types of analgesics. Halm's study shows that pain ratings are reduced when there is pretreatment with analgesics. Although the studies by Valdovinos et al. and Halm used different methods, they resulted in the same outcome: a reduction in pain.

Thank you for the opportunity to respond to this article.