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LETTER TO THE EDITOR

Patient Comfort in Regional Anesthesia

Department of Anesthesiology and Intensive Care; University Hospital of Toulouse; Toulouse, France; vincentminville{at}yahoo.fr

In Response:

We agree with O’Sullivan1 that patient comfort during regional anesthesia is an important issue, and we were surprised that euctectic mixture of local anesthetic (EMLA®) cream reduced pain from both needle puncture and needle redirection during humeral block placement in non-sedated patients.2

In an earlier study, we determined that trauma patients experienced less discomfort during infraclavicular block than during humeral block.3 We explained this result by the degree of twitch diminution (2 vs 4), i.e., the fracture movement. However, an unexpected finding of that study was that the skin puncture was painful. Consequently, the objective of the current study was to assess the ability of EMLA® cream to decrease pain from skin puncture in patients undergoing selective surgery.2 Interestingly, we found that EMLA® cream decreases pain from skin puncture as well as the pain during performance of a humeral block.2

We also agree with O’Sullivan that the expanding role of ultrasound in regional anesthesia will further enhance patient comfort and satisfaction by avoiding uncomfortable muscle twitches and decreasing the number of needle passes. This, however, has yet to be unequivocally demonstrated.4 In addition, the decreased volume of local anesthetics will hardly contribute to an improvement in patient comfort.

In summary, whether nerve stimulation or ultrasound guidance is being used, the skin puncture is always the first step in the performance of regional anesthesia. So, why not also use EMLA® cream before performing an ultrasound guided nerve block?

REFERENCES

1. O’Sullivan MJ. Patient comfort in regional anesthesia. Anesth Analg 2008;106:349[Free Full Text]
2. Samson D, Minville V, Chassery C, Nguyen L, Pianezza A, Fourcade O, Rabinowitz A, Samii K. Eutectic Mixture of Local Anesthetic (EMLA) decreases pain during humeral block placement in non-sedated patients. Anesth Analg 2007;105:512–5[Abstract/Free Full Text]
3. Minville V, Fourcade O, Idabouk L, Claassen J, Chassery C, Nguyen L, Pourrut JC, Benhamou D. Infraclavicular brachial plexus block versus humeral block in trauma patients: a comparison of patient comfort. Anesth Analg 2006;102: 912–5[Abstract/Free Full Text]
4. Casati A, Danelli G, Baciarello M, Corradi M, Leone S, Di Cianni S, Fanelli G. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology 2007;106:992–6[Web of Science][Medline]

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