https://doi.org/10.4081/ecj.2026.14680
Comparison of low-cost interventions for pain during radial arterial blood gas sampling in the emergency department: a three-arm randomised controlled trial
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Published: 22 May 2026
This study evaluated the efficacy of topical anaesthesia and cryo-analgesia for pain management during radial Arterial Blood Gas (ABG) sampling, compared with standard care. An open-label, randomised controlled trial with blinded statistical analysis in a Thai emergency department (July–September 2024) included 126 adults requiring ABG sampling. Participants were randomised to receive topical anaesthesia (10% lidocaine spray), cryo-analgesia (cold pack), or standard care (2% chlorhexidine) two minutes prior to the procedure. The primary outcome was participant-reported pain, assessed via the Numeric Rating Scale (NRS) during the procedure and 30 seconds post-procedure. ANOVA determined significant differences in pain scores. Statistical significance was set at p<0.05. All 126 participants completed the study (42 participants per group). Mean NRS pain scores did not differ significantly among the groups during the procedure [F(2,123)=0.62, p=0.54] or 30 seconds post-procedure [F(2,123)=0.35, p=0.71] Cryo-analgesia achieved the highest first-attempt success rate (83.3%, p=0.42). No immediate complications occurred within 5 minutes. Neither topical anaesthesia nor cryo-analgesia provided superior pain management compared with standard care during radial ABG sampling. These findings represent an absence of evidence for superiority, rather than evidence of clinical equivalence.
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CRediT authorship contribution
Conceptualization: SV, CT, PS; Data curation: CT, SV, PS; Formal analysis: TL, CT, TS; Funding acquisition: SV, PS; Methodology: CT, TL, PV, PT; Supervision: SV, PS; Writing–original draft: CT, TL, PV, PT; Writing–review & editing: all authors. All authors read and approve the final manuscript.
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