Local Anesthetics for Pain Reduction Prior to IV Line Placement

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.