Pain and discomfort management during central venous catheter insertion

The insertion of a central venous catheter (CVC) is one of the most frequently performed invasive procedures in anesthesia and critical care settings. It may be associated with considerable discomfort in the conscious patient, as it requires him/her to stay in Trendelenburg position, head-extended with the neck fully turned to the opposite side and perfectly still. Local anesthetics such as lidocaine are commonly used to reduce pain during the procedure. However, even after the establishment of an effective fi eld block, subsequent steps such as anchoring of the catheter to the skin by suture or the eventual catheter tunneling are a source of pain and distress. The fi eld infi ltration with local anesthetics may be associated itself with signifi cant pain.