Comparative Evaluation of Efficacy of Transdermal Diclofenac Patch, Eutectic Mixture of Local Anaesthetic Cream and Placebo for Venous Cannulation Pain and Attenuation of Hemodynamic Response

Purpose: Venous cannulation is painful and associated with a high incidence of vasovagal and pressor responses. The aim of this study is to evaluate the efficacy of transdermal diclofenac patch (TDP) and eutectic mixture of local anaesthetics (EMLA) cream for intravenous cannulation pain and to attenuate the haemodynamic response to it. Methods: This was a prospective, randomized, double blind, placebo controlled study in which 102 adult ASA I and II patients undergoing elective surgery of both sexes were divided into three groups. Group P received placebo cream, Group E received EMLA cream 2gm/10cm2 and Group D received TDP 100mg/50cm2, at the proposed site, 60min prior to the insertion of a 18G IV cannula. The resulting pain was assessed by VAS. The heart rate and blood pressure was recorded before and at 1min of Intravenous cannulation to assess the stress response. Results: TDP and EMLA cream were effective in reducing both the incidence and severity of pain in comparison to the placebo group and also attenuated the stress response to it. Conclusion: TDP can be used as an alternative to EMLA cream for reducing the incidence and severity of venous cannulation pain and for attenuating the haemodynamic response, in patients who are sensitive to EMLA cream.