The Efficacy and Feasibility of a Collaborative Approach for Reducing Pain in ED Lumbar Puncture Patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/162890
Type:
Presentation
Title:
The Efficacy and Feasibility of a Collaborative Approach for Reducing Pain in ED Lumbar Puncture Patients
Abstract:
The Efficacy and Feasibility of a Collaborative Approach for Reducing Pain in ED Lumbar Puncture Patients
Conference Sponsor:Emergency Nurses Association
Conference Year:2003
Author:Strout, Tania D., RN, BSN
P.I. Institution Name:Maine Medical Center
Contact Address:Dept. of Emergency Medicine, 321 Brackett Street, Portland, ME, 04103, USA
Contact Telephone:207/842-7049
Co-Authors:Alyce A. Schultz, RN, PhD; John H. Burton, MD; Pamela Jordan, RN, BSN; and Barry Worthing, RN, BSN
Purpose: To compare the effectiveness of lidocaine administered via iontophoresis and injection for dermal anesthesia prior to adult emergency department (ED) lumbar puncture (LP) and to assess the feasibility of nurse-applied anesthesia in this population. Design: A prospective, randomized, IRB-approved trial based on the physiological pain theory. Setting: A Level 1, tertiary care ED located in New England that houses an ED residency training program. Sample: Adult ED patients requiring LP. Methodology: Following informed consent by an emergency registered nurse (EDRN), subjects were randomized to receive lidocaine anesthesia by iontophoresis or needle injection. In iontophoresis patients, the EDRN collaborated with the physician on placement and administered the anesthesia. In injection patients, a physician performed lidocaine injection in the usual fashion. "Rescue" lidocaine was provided via injection for either group when necessary. Pain was measured on an 11-point numeric rating scale (NRS-11) prior to LP, during lidocaine administration, and following LP. Provider satisfaction with the procedure and observations of patient pain were recorded. Results: Ninety-two patients enrolled, ninety completed the protocol: 49 injection group and 43 iontophoresis group pts. Twelve injection patients (24.5%) and 18 iontophoresis patients (43.9%) required rescue lidocaine (p=-19, chi-square). Baseline NRS-11 scores were similar between groups. Mean score during lidocaine administration was 0.9 for iontophoresis versus 4.1 for injection (difference between means -3.2, 95% CI: -4.1 to -2.3). Mean score during LP was 3.7 for iontophoresis compared to 3.4 for injection (difference between means 0.30, 95% CI: -0.9 to 1.4). Sixty-five percent of EDRNs and sixty-three percent of physicians reported greater satisfaction with the collaborative procedure compared to physician administered lidocaine injection. Conclusions: Patients undergoing ED LP report significantly less discomfort with lidocaine administered by iontophoresis when compared to injection, with similar pain during the LP procedure. ED providers reported greater satisfaction with the collaborative procedure compared to physician administered anesthesia.
Implications: Adding lidocaine anesthesia by iontophoresis in patients undergoing LP decreases pain, increases satisfaction and fosters collaborative practice in the ED setting. [Research Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Efficacy and Feasibility of a Collaborative Approach for Reducing Pain in ED Lumbar Puncture Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162890-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Efficacy and Feasibility of a Collaborative Approach for Reducing Pain in ED Lumbar Puncture Patients</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2003</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Strout, Tania D., RN, BSN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Maine Medical Center</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Dept. of Emergency Medicine, 321 Brackett Street, Portland, ME, 04103, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">207/842-7049</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">strout@mmc.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Alyce A. Schultz, RN, PhD; John H. Burton, MD; Pamela Jordan, RN, BSN; and Barry Worthing, RN, BSN</td></tr><tr><td colspan="2" class="item-abstract">Purpose: To compare the effectiveness of lidocaine administered via iontophoresis and injection for dermal anesthesia prior to adult emergency department (ED) lumbar puncture (LP) and to assess the feasibility of nurse-applied anesthesia in this population. Design: A prospective, randomized, IRB-approved trial based on the physiological pain theory. Setting: A Level 1, tertiary care ED located in New England that houses an ED residency training program. Sample: Adult ED patients requiring LP. Methodology: Following informed consent by an emergency registered nurse (EDRN), subjects were randomized to receive lidocaine anesthesia by iontophoresis or needle injection. In iontophoresis patients, the EDRN collaborated with the physician on placement and administered the anesthesia. In injection patients, a physician performed lidocaine injection in the usual fashion. &quot;Rescue&quot; lidocaine was provided via injection for either group when necessary. Pain was measured on an 11-point numeric rating scale (NRS-11) prior to LP, during lidocaine administration, and following LP. Provider satisfaction with the procedure and observations of patient pain were recorded. Results: Ninety-two patients enrolled, ninety completed the protocol: 49 injection group and 43 iontophoresis group pts. Twelve injection patients (24.5%) and 18 iontophoresis patients (43.9%) required rescue lidocaine (p=-19, chi-square). Baseline NRS-11 scores were similar between groups. Mean score during lidocaine administration was 0.9 for iontophoresis versus 4.1 for injection (difference between means -3.2, 95% CI: -4.1 to -2.3). Mean score during LP was 3.7 for iontophoresis compared to 3.4 for injection (difference between means 0.30, 95% CI: -0.9 to 1.4). Sixty-five percent of EDRNs and sixty-three percent of physicians reported greater satisfaction with the collaborative procedure compared to physician administered lidocaine injection. Conclusions: Patients undergoing ED LP report significantly less discomfort with lidocaine administered by iontophoresis when compared to injection, with similar pain during the LP procedure. ED providers reported greater satisfaction with the collaborative procedure compared to physician administered anesthesia. <br/>Implications: Adding lidocaine anesthesia by iontophoresis in patients undergoing LP decreases pain, increases satisfaction and fosters collaborative practice in the ED setting. [Research Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:35:54Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:35:54Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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