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Comparison of EMLA and Diclofenac on Reduction of Pain and Phlebitis Caused by Peripheral IV Catheter

A Randomized-Controlled Trial Study

Babaieasl, Faezeh, PhD, MSN; Yarandi, Hossein N., PhD; Saeidzadeh, Seyedehtanaz, MSN; Kheradmand, Motahareh, PhD, MSN

doi: 10.1097/NHH.0000000000000704
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Peripheral venous catheters (PVC) are often used to provide hydration, medications, and blood products when the length of therapy is expected to be less than 1 week. Pain and phlebitis are frequent complications of PVC. Diclofenac and EMLA have been used to minimize these adverse effects; however, conflicting results have been reported regarding which has better outcomes. This double-blind, randomized controlled trial was conducted to compare the efficacy of EMLA and Diclofenac (TDP) in attenuating PVC pain and phlebitis. The inpatient setting was chosen because of the higher frequency of PVC insertions, allowing for a sufficient sample size. One hundred fifty-four subjects were randomly assigned to three groups: EMLA patch (n = 61), a TDP patch (n = 50), or a patch with lubricant gel (n = 46) as a placebo. The pain was measured by Visual Analogue Scale (VAS). Phlebitis was examined based on Boxter criteria in intervals of 6, 12, 18, 24, and 48 hours after PVC insertion. The mean score of VAS was 41.86 ± 22.49 for the control, 39.40 ± 21.60 for TDP, and 38.77 ± 23.28 for the EMLA group, with no significant differences in pain severity between the three groups. The rate of phlebitis in the group with EMLA was significantly higher than the other two groups at 6, 12, and 18 hours (p = 0.02, p = 0.003 and p = 0.04, respectively). In all interval times, the rate of phlebitis in the TDP group was significantly lower than the other groups. Compared with men, women experienced higher rate of phlebitis and intensity of PVC pain. EMLA and TDP had similar analgesic effects, but phlebitis was less frequently observed with TDP, suggesting TDP as a potential medication for reducing pain and phlebitis before PVC insertion.

Faezeh Babaieasl, PhD, MSN, College of Nursing, Wayne State University, Detroit, Michigan.

Hossein N. Yarandi, PhD, is a Professor, Office of Health Research, College of Nursing, Wayne State University, Detroit, Michigan.

Seyedehtanaz Saeidzadeh, MSN, is a PhD Student, College of Nursing, Iowa City, Iowa.

Motahareh Kheradmand, PhD, MSN, is Assistant Professor, Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.

The authors would like to extend their deepest gratitude to the Vice-Chancellery for Research and Technology of Babol University of Medical Sciences for its financial support, and to the staff and patients in the cardiology ward and CCU for their cooperation in this study. They also like to thank Fatemeh Saberain, Maryam Sohrabi, and Sakineh Rahmani for their dedication in collecting data for the study.

The authors declare no conflicts of interest.

Address for correspondence: Faezeh Babaieasl, PhD, MSN, College of Nursing, Wayne State University, 5557 Cass Avenue, Detroit, MI 48202 (fc1002@wayne.edu).

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