| Learning Objective #1: Discuss the use of iontophoresis in adult lumbar puncture patients | |||
| Learning Objective #2: Discuss the value of interdisciplinary research in clinical nursing |
Objective: 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 of adult pts requiring LP in our Level 1, tertiary care ED, based on the physiological pain theory. Methods: Following informed consent, subjects were randomized to receive lidocaine anesthesia by iontophoresis or needle injection. In iontophoresis pts, the RN collaborated with the physician (MD) on placement and administered the anesthesia. In injection pts, an MD 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 pt pain were recorded. Findings: Eighty-nine patients enrolled, eighty-seven completed the protocol: 49 injection group and 38 iontophoresis group pts. Twelve injection pts (24.5%) and 17 iontophoresis pts (44.7%) required rescue lidocaine (p=0.5, 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 3.3, 95% CI: -4.2 to -2.3). Mean score during LP was 3.9 for iontophoresis compared to 3.4 for injection (difference between means 0.5, 95% CI: -0.7 to 1.7). Sixty-six percent of providers 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. Providers reported greater satisfaction with the collaborative procedure compared to physician administered anesthesia. Implications: Adding lidocaine anesthesia by iontophoresis in pts undergoing LP decreases pain, increases satisfaction and fosters collaborative practice.
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