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I was delighted with Dr Yentis' editorial (April 2005 JRSM1) but dismayed by Dr Petrou's letter and her view that she 'can see no argument for the use of local anaesthesia in routine ward cannulation'.2 Thirty-two years of anaesthetic practice prompts me to suggest an argument to her. Why has surgery blossomed since the introduction of anaesthesia? The essential reason is that the operative site stays still and surgeons can do their work carefully. Insertion of a venous cannula is no different from any other operation; it is much easier if the operative site is insensible and stays still. Whether the injection of intradermal lidocaine hurts as much as cannula insertion is not the point. The point is that if you know that the patient will not flinch, you can introduce your needle in an elegant controlled way instead of with a desperate stab.
If it is true that 'ward doctors' cannot obtain lidocaine then they can use saline instead. A bleb of intradermal (not subcutaneous) saline works about as well as lidocaine, presumably by crushing nerve fibres.3 The effect of intradermal lidocaine or saline is instantaneous so that even in emergency situations the small additional period of time required is worthwhile, because your chances of first-time success are increased and what really wastes time is multiple failure.