What is the recommended technique for using local anesthesia during arteriopuncture?

From the Guidelines

Local anesthesia is optional before arteriopuncture, and its use can significantly reduce patient discomfort during the procedure. When using local anesthesia, it is essential to follow a recommended technique to minimize pain and ensure procedural accuracy.

Recommended Technique

The technique involves subcutaneous infiltration of 1% lidocaine without epinephrine at the puncture site, as supported by guidelines for minimizing pain in dermatologic procedures 1. After cleaning the area with an antiseptic solution, use a 25-gauge or smaller needle to inject 0.3-0.5 mL of lidocaine just beneath the skin, creating a small wheal directly over the artery.

Key Considerations

• Wait 30-60 seconds for the anesthetic to take effect before performing the arterial puncture.
• Avoid injecting directly into the artery or using excessive amounts of anesthetic that could obscure anatomical landmarks.
• Buffering the lidocaine with sodium bicarbonate (9:1 ratio of lidocaine to sodium bicarbonate) can reduce the burning sensation during injection, as suggested by recommendations for minimizing pain of administration of local infiltration anesthesia 1.

Alternative Anesthetics

For patients with lidocaine allergies, alternative anesthetics like bupivacaine 0.25% can be used, though these typically have a slower onset of action.

Minimizing Pain

Slow rate of infiltration, vibration of the skin, use of a warm solution, or cold air skin cooling should be considered to decrease the pain of local anesthetic injection, as recommended by guidelines for the use of local anesthesia in office-based dermatologic surgery 1. Some key points to consider when using local anesthesia during arteriopuncture include:

• The use of local anesthesia is optional but can significantly reduce patient discomfort.
• Lidocaine without epinephrine is the recommended anesthetic.
• A slow rate of infiltration and other methods to decrease pain should be considered.
• Alternative anesthetics are available for patients with lidocaine allergies.

From the Research

Local Anesthesia in Arteriopuncture

• Local anesthesia is not contraindicated before arteriopuncture, but its use may vary among practitioners 2.
• The use of anesthetics with epinephrine before arteriopuncture does not necessarily reduce the incidence of post-procedure hematoma, but it is safe to use in areas with end-arteries 3, 4.
• If local anesthesia is used, it is recommended to inject the smallest amount necessary slowly into the deep dermal-subcutaneous tissue as the needle is being slowly withdrawn to minimize discomfort 5.
• Intradermal injection of lidocaine around the puncture site decreases the incidence and severity of localized pain when used before arterial puncture 2.

Technique for Local Anesthesia

• A superficial wheal-producing dermal injection is uniformly much more painful than that into the deep dermal-subcutaneous tissue region 5.
• Rapid injection almost always hurts more than slow injection 5.
• The addition of sodium bicarbonate to lidocaine with epinephrine can reduce the pain of infiltration 6.

Recommended Option

• The correct option is: If local anesthesia is used, both a superficial wheal and a deeper injection should be used is not the best answer based on the provided evidence.
• A more accurate answer would be: Local anesthesia is optional before arteriopuncture, and if used, it should be injected slowly into the deep dermal-subcutaneous tissue 5, 2.