Waiting Time for Lignocaine (Lidocaine) Jelly Before Cannulation
For optimal anesthetic effect, lignocaine jelly should be applied to intact skin 5-10 minutes before cannulation. 1
Evidence-Based Timing Recommendations
The onset of action for topical lignocaine varies based on formulation and application site:
- Standard lignocaine jelly: 5-10 minutes for adequate anesthesia 1
- Liposomal topical lidocaine: Full effectiveness in 30 minutes 2
- Heated topical lidocaine: Full effectiveness in 20 minutes 2
- EMLA cream (lidocaine/prilocaine): Full effectiveness in 60 minutes 2, 1
Application Technique
For optimal results when using lignocaine jelly:
- Apply to intact skin over potential cannulation sites
- Use sufficient quantity (typically 2-5g) to cover the area
- Cover with an occlusive dressing if available
- Allow adequate time for absorption and anesthetic effect
- Consider applying to multiple potential sites to provide options for cannulation 2, 1
Special Considerations
Pediatric Patients
- Use lower doses for children <12 months old or weighing <10 kg 2
- Consider applying to at least 2 sites over veins amenable to placement 2
- Pediatric patients particularly benefit from adequate waiting time to ensure full anesthetic effect 2
Contraindications
- Emergent need for IV access (insufficient time for onset of action)
- Allergy to amide anesthetics
- Nonintact skin (except for specific formulations designed for wound care) 2, 1
Alternative Options
If rapid anesthesia is required:
- Vapocoolant sprays: Immediate onset but less effective in children 2
- Intradermal lidocaine injection: Faster onset but requires needle insertion 2
- High velocity lignocaine particles: Provides significant skin anesthesia at the antecubital fossa in approximately 4 minutes 3
- 10% lidocaine spray: Effective within 10 minutes, comparable to EMLA's 60-minute application 4
Pharmacology Considerations
Lignocaine jelly works by stabilizing neuronal membranes through inhibition of ionic fluxes required for impulse initiation and conduction 5. The onset of action is typically 3-5 minutes when applied to mucous membranes, but it is generally ineffective when applied to fully intact skin without proper formulation or application time 5.
Clinical Pearls
- Patient education is important - inform them that topical lidocaine reduces but may not completely eliminate pain 1
- Avoid mucous membrane contact or ingestion when using on intact skin 1
- Successful analgesia improves procedural success rates by decreasing patient movement 1
- The cannulation site affects anesthetic efficacy - antecubital fossa typically responds better than the back of the hand 3
Remember that while 5-10 minutes is generally sufficient for basic anesthesia with lignocaine jelly, allowing additional time (up to 30 minutes) may provide more complete anesthesia for patients with high anxiety or low pain tolerance.