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J R Soc Med. 2005 June; 98(6): 292.
PMCID: PMC1142246

The pain of venous cannulation

Dr Sado and Dr Deakin (April 2005 JRSM1) refer to some of the practical reasons why ward doctors are less likely than anaesthetists to use local anaesthesia for vein cannulation. One of them is access to lidocaine. On an eight-hour shift a ward doctor might have to insert up to twenty cannulas; and, if on each occasion the lidocaine has to be produced from a locked cupboard by a nurse, time does not permit. However, time is not the issue here. I do not accept Sado and Deakin's conclusion that patients are suffering 'more pain than necessary'. Assessing the effect of local anaesthesia for vein cannulation, Rohm et al.2 in a recent study, found clear benefits for cannulae of 16G or greater but no advantages for 18G (green) and 20G (pink). These smaller cannulae are the ones used most often on the ward. If a 14G cannula is needed, this will probably be an emergency where local anaesthesia would unduly delay treatment. The arguments of Sado and Deakin are hazardous because they could be used unfairly in medicolegal cases. I see no argument for use of local anaesthesia in routine ward cannulation.


1. Sado DM, Deakin CD. Local anaesthesia for venous cannulation and arterial blood gas sampling: are doctors using it? J R Soc Med 2005;98: 158-60 [PMC free article] [PubMed]
2. Rohm KD, Schollhorn TA, Gwosdek MJ, Piper SN, Maleck WH, Boldt J. Do we necessarily need local anaesthetics for venous cannulation? A comparison of different cannula sizes. Eur J Anaesthesiol 2004;21: 214-16 [PubMed]

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