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Related Experiment Video

Updated: Feb 21, 2026

Femoral Arterial and Venous Catheterization for Blood Sampling, Drug Administration and Conscious Blood Pressure and Heart Rate Measurements
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Pain During Venous Cannulation.

Dirk Rüsch1, Tilo Koch, Markus Spies

  • 1Clinic of Anesthesiology and Intensive Care Medicine, Philipps-University Marburg; UKGM Giessen and Marburg.

Deutsches Arzteblatt International
|October 5, 2017
PubMed
Summary

Local anesthesia, like vapocoolant spray, effectively reduces venipuncture pain with larger cannulas (17G). For smaller cannulas (20G), the pain reduction is less significant.

Area of Science:

  • Anesthesiology
  • Pain Management
  • Medical Devices

Background:

  • Venous puncture pain is a significant patient concern.
  • Current literature lacks comprehensive data on local anesthesia efficacy relative to cannula size.
  • This study addresses the efficacy of local anesthesia versus placebo for venipuncture pain, considering cannula size.

Purpose of the Study:

  • To evaluate the efficacy of local anesthesia (lidocaine and vapocoolant spray) in reducing venipuncture pain.
  • To compare the effects of local anesthesia with placebo across different venous cannula sizes.
  • To assess the impact of local anesthesia on the success rate of venipuncture.

Main Methods:

  • A randomized, controlled trial with a fully factorial design was conducted.

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  • Patients received either lidocaine, vapocoolant spray, or placebo before venipuncture.
  • Pain was assessed using a Numerical Rating Scale (NRS), and puncture success rates were recorded.

    • Main Results:

    • For 17G cannulas, both vapocoolant spray (NRS 2.6) and lidocaine (NRS 3.5) significantly reduced pain compared to placebo (NRS 5.0).
    • Vapocoolant spray showed a clinically relevant reduction in pain for 17G cannulas (p < 0.0001).
    • For 20G cannulas, vapocoolant spray offered a statistically but not clinically relevant pain reduction. Lidocaine pretreatment resulted in a higher rate of unsuccessful punctures (12.7%) compared to vapocoolant spray (4.7%) and placebo (4.0%).

    Conclusions:

    • Local anesthesia is recommended for venipuncture only when using large cannulas (≥ 17G).
    • Vapocoolant spray is a viable alternative to lidocaine, offering comparable pain relief with a lower failure rate.
    • The choice of local anesthetic and cannula size significantly impacts patient comfort and procedural success.