Question

What type of analgesia is used to access an implanted port for vesicant administration?

Answer 1

Vesicants are drugs that can cause chemical burns and tissue necrosis,if accidentally enters the tissue near the infusion site.They produce blisters and cause pain .Examples are doxorubicin,daunorubicin,actinomycin D etc.

Some patients may tolerate the pain.But usually anaesthetic agents are used prior to accessing the port for vesicant administration. Commonly used anaesthetic agent is topical lidocaine 2.5% and prilocaine 2.5% cream(EMLA cream).But this will take some time for its action.Hence it should be applied few hours prior to accessing the port.Its action last for a sufficient time till the vesicant is administered.So topical anaesthetic creams are the best option. Intradermal anaesthetics can also be given.But there are chances of infection, due to additional needle pricks.Topical anaesthetics sprays(ethyl chloride) can also be used.But it has a very short duration of action.It should be sprayed keeping a distance of 3-9 inches for few seconds. Over spraying can also causes skin irritation.