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ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH

A Needle-Free Jet-Injection System with Lidocaine for Peripheral Intravenous Cannula Insertion: A Randomized Controlled Trial with Cost-Effectiveness Analysis

Division of Anesthesiology, Department of APSIC (Anesthesiology, Pharmacology, and Surgical Intensive Care), Geneva University Hospitals, Switzerland

Address correspondence and reprint requests to Christopher Lysakowski, MD, Division of Anesthesiology, Department APSIC, Rue Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland. Address e-mail to lysakowski.christopher{at}hcuge.ch

Insertion of a peripheral IV cannula is a common, although painful, procedure. We tested the analgesic efficacy, adverse effects, and cost-effectiveness of a needle-free intradermal drug delivery system (Jet) with lidocaine for the insertion of an IV cannula (18-gauge; dorsum of hand). Four-hundred patients were randomly allocated to one of four groups: (a) no treatment, (b) Jet (J-Tip^®, National Medical Products Inc, CA; $3.0 per device) with 0.5 mL of saline, (3) Jet with 0.5 mL of lidocaine 1%, and (4) Jet with 0.5 mL of lidocaine 2%. Pain was evaluated using a numerical verbal scale (NVS 0–10). A NVS 3 was considered as acceptable in this context. Incremental cost-effectiveness ratios were calculated. Without treatment, 42.4% of patients had a NVS 3, 39.3% with saline, 60.7% with 1% lidocaine (relative risk [RR] compared with no treatment, 0.70; 95% confidence interval [CI], 0.53–0.93), and 86.7% with 2% lidocaine (RR, 0.49; 95% CI, 0.38–0.62). Nineteen and one-half percent of patients had a NVS >3 because of Jet treatment, 13.5% had local hyperemia, and 16.9% had minor local bleeding. Of all Jet treatments, 10.5% were technical failures, and there were 17.6% cannula insertion failures (10.1% without treatment [RR, 1.74; 95% CI, 0.92–3.32]). Compared with no treatment, costs to generate one additional patient with a NVS 3 were $23 with lidocaine 1% and $10 with lidocaine 2%. On insertion of an IV cannula on the back of the hand, 58% of patients report at least moderate pain. Lidocaine-Jet is analgesic; there is dose-responsiveness. However, Jet treatment is not painless, and costs incurred to achieve one success compared with doing nothing are not negligible.

IMPLICATIONS: Insertion of an IV cannula is painful. Four-hundred patients were randomly allocated to test the analgesic efficacy, adverse effects, and cost-effectiveness of the needle-free intradermal drug delivery system (J-Tip^®; Jet). Jet with lidocaine is effective, but its application is not painless. Costs to achieve one patient with no more than moderate pain (numerical verbal scale 3 of 10) on insertion of an IV cannula are $10.

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