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Al-Jubouri MB, Jaafar SA, Abbas MK, Gazi IN, Shawwat MA, Karmoud KF, Al-Faham TM. Using cryotherapy, EMLA (eutectic lidocaine/prilocaine) cream, or lidocaine spray to reduce pain during arteriovenous fistula puncture: A randomized controlled trial. Hemodial Int 2024. [PMID: 38605472 DOI: 10.1111/hdi.13152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION In hemodialysis patients, pain associated with needle insertion into an arteriovenous fistula is a physical and psychological problem. The aim of this study was to assess the effectiveness of pre-puncture application of an ice pack, EMLA cream, or lidocaine spray to reduce pain associated with access puncture. METHODS This was a multicenter study done in nine hemodialysis centers in Iraq. The study utilized a randomized, parallel-group design, in which patients being dialyzed using an arteriovenous access were allocated into one of four groups. Access puncture was preceded by nothing (control group), by use of ice pack cooling at the puncture site, by application of EMLA cream, or by application of lidocaine spray. Pain after access puncture was assessed during a single treatment for each patient. Pain was quantified using a Visual Analogue Scale. FINDINGS A total of 1548 patients agreed to participate, and 1041 patients were included in the data analysis. Use of an ice pack, EMLA cream, or lidocaine spray each was associated with a lower pain score on access puncture compared with no pretreatment. The mean Visual Analogue Scores in the four groups were: 69.7 ± 15.7 in the controls, 39.8 ± 13.2 in the ice pack group, 45 ± 18.4 in the EMLA group, and 52.9 ± 15.2 in lidocaine group. Ranking of the pain severity scores suggested that ice pack use was associated with the least pain, followed by use of EMLA cream and use of lidocaine spray (severity score ranking, from lowest to highest, being 1.62, 2.18, and 2.63, respectively). DISCUSSION Application of an ice pack prior to vascular access puncture is a fast and inexpensive technique to limit pain associated with this procedure.
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Affiliation(s)
| | - Sabah A Jaafar
- Adult Nursing Department, College of Nursing, University of Al-Muthanna, Al-Samawa, Iraq
| | | | | | - Maitham A Shawwat
- Hemodialysis Department, Al-Hussain Teaching Hospital, Al-Samawa, Iraq
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Gautam S, Mall P, Prakash R, Yadav K, Raman R, Singh MK. Efficacy of ShotBlocker device versus vapocoolant spray for spinal needle pain relief during spinal anaesthesia in elective caesarean section - A randomised controlled trial. Indian J Anaesth 2024; 68:329-333. [PMID: 38586263 PMCID: PMC10993942 DOI: 10.4103/ija.ija_845_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background and Aims Apprehension of pain due to a spinal needle is often a cause of anxiety and refusal. ShotBlocker provides non-painful physical stimulation, inhibiting pain perception. The vapocoolant spray contains ethyl chloride vapours, rapidly raising the skin temperature and hampering the transmission of noxious stimuli. The present study compared the effectiveness of the ShotBlocker device and the vapocoolant spray in reducing spinal needle-associated pain in primigravida women undergoing elective lower-segment caesarean section (LSCS). Methods We enroled 144 primigravida women undergoing elective LSCS and were randomised to Group SB (the ShotBlocker device was firmly pressed over the skin, and the spinal needle was inserted through its slit), Group V (the vapocoolant spray was applied at the puncture site before spinal needle insertion), and Group C (received local infiltration before spinal anaesthesia (SA)). The groups were compared for needle-associated pain and patient satisfaction using a 10-point visual analogue scale (VAS) and a 3-point Likert scale. Results The mean (standard deviation) [95% confidence interval (CI)] VAS scores of Group SB 3.85 (0.74) [3.64, 4.07] and Group V 3.04 (0.74) [2.83, 3.26] were significantly lower than that of Group C 5.19 (0.92) [3.28, 3.62]). On the Likert scale, the maximum number of patients in the vapocoolant group (64.6%) responded satisfactorily, while in the control group, the majority (62.5%) of participants responded dissatisfied (P < 0.001). Conclusion Both the ShotBlocker and vapocoolant spray reduce needle puncture-associated pain before SA in primigravida patients undergoing elective LSCS. However, the vapocoolant spray is more beneficial in reducing spinal needle-associated pain than the ShotBlocker device.
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Affiliation(s)
- Shefali Gautam
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Pratibha Mall
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Ravi Prakash
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Kirtika Yadav
- Department of Anaesthesiology, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Rajesh Raman
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Manish K. Singh
- Department of Anaesthesiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
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Namazinia M, Mohajer S, Abbaspour S, Lopez V, Sarboozi-Hoseinabadi T. Effects of virtual reality on pain induced by arteriovenous fistula needle insertion in patients undergoing hemodialysis: A randomized clinical trial. J Vasc Access 2024:11297298231225755. [PMID: 38326286 DOI: 10.1177/11297298231225755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is characterized by irreversible damage to renal function. For patients undergoing replacement therapies like hemodialysis (HD), the pain caused by arteriovenous fistula (AVF) cannulation becomes a significant aspect of their daily lives. This study aimed to examine the impact of virtual reality (VR) distraction techniques on the pain experienced during AVF needle insertion in patients undergoing HD. MATERIALS AND METHODS This randomized clinical trial (RCT) recruited a total of 60 patients undergoing HD from the 9 Dey Hospital in Torbat Heydariyeh, Iran, between March and August 2022. These patients were then divided into two groups: the intervention group and the control group. The intervention group received distraction techniques using the Shinecon 4th Gen Virtual Reality Headset, while the control group received routine care services. To assess the level of pain experienced during AVF cannulation, the Visual Analog Scale (VAS) was utilized. The collected data were analyzed using SPSS20. Various statistical tests, including the Chi-square test, Mann-Whitney U test, Multiple linear regression, and independent-samples t-test, were employed for data analysis. Additionally, Cohen's d was used to determine the effect size of the intervention. RESULTS The analysis of the data revealed a statistically significant difference in the mean (SD) pain scores between the control group (7.6 ± 0.8) and the intervention group (5.1 ± 0.9) (p < 0.002 after Bonferroni correction). Furthermore, it was observed that a majority of patients in the intervention group reported experiencing moderate pain, whereas the control group experienced more severe pain. CONCLUSIONS The study findings demonstrated that the use of virtual reality (VR) was effective in reducing the intensity of pain experienced during AVF needle insertion in patients undergoing HD. Based on these results, it is recommended to incorporate VR as a routine practice in the HD department of the hospital. TRIAL REGISTRATION This study, with the code no. IRCT20180429039463N3, was registered on the Iranian Registry of Clinical Trials on 28/03/2022.
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Affiliation(s)
- Mohammad Namazinia
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
| | - Samira Mohajer
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seddigheh Abbaspour
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Tahere Sarboozi-Hoseinabadi
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
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Shahri HA, Salmi IA, Rajhi WA, Shemshaki H. Effectiveness of the Eutectic Mixture of Local Anaesthetics Cream in the Management of Arteriovenous Fistula Needle Insertion Pain in Patients Undergoing Haemodialysis. Sultan Qaboos Univ Med J 2024; 24:7-19. [PMID: 38434453 PMCID: PMC10906758 DOI: 10.18295/squmj.10.2023.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/27/2023] [Accepted: 10/03/2023] [Indexed: 03/05/2024] Open
Abstract
This review aimed to assess the effectiveness of the eutectic mixture of local anaesthetics (EMLA) cream in the management of arteriovenous fistula (AVF) needle insertion pain in adult patients undergoing haemodialysis (HD) compared with other alternative interventions. The main search was conducted in November 2020 and updated in December 2021. In the search strategy, keywords and synonyms were used and multiple databases were searched with no date limitation to ensure a comprehensive search that would yield all studies relevant to the review and minimise location bias. A total of 209 studies were found in this search and filtered. After filtering through these studies, only five studies were finally included in the review. EMLA-cream was found to be effective in reducing AVF needle insertion pain among adult patients undergoing HD. Despite EMLA cream's effectiveness in reducing HD needle insertion pain and its fewer side effects, the findings of the included studies should be interpreted with caution, as there are some limitations, and further research is required.
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Affiliation(s)
- Hamed Al Shahri
- Renal Medicine Department, Sultan Qaboos Hospital, Salalah, Oman
| | - Issa Al Salmi
- Department of Renal Medicine, The Royal Hospital, Muscat, Oman
| | - Waleed Al Rajhi
- College of Pharmacy and Nursing, Nizwa University, Nizwa, Oman
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Yamada Y, Kitamura M, Inayama E, Kishida M, Kataoka Y, Ikenoue T. Acoustic stimulation for relieving pain during venipuncture: a systematic review and network meta-analysis. BMJ Open 2023; 13:e077343. [PMID: 38135307 DOI: 10.1136/bmjopen-2023-077343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES To assess whether acoustic stimulations relieve venipuncture pain and determine which stimulation is the most effective type. DESIGN Systematic review and network meta-analysis. DATA SOURCES PubMed, Cochrane Central Register of Controlled Trials, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov and the International Clinical Trials Registry Platform databases were systematically searched in September 2023. STUDY SELECTION Randomised controlled trials evaluating the efficacy of acoustic stimulations on patients undergoing venipuncture were eligible. Acoustic stimulations were classified into seven categories: five types of acoustic stimulations (music medicine (researcher selected), music medicine (patient selected), music therapy, sounds with linguistic meaning and sounds without linguistic meaning) and two controls (only wearing headphones and no treatment). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes included self-reported pain intensity assessed during venipuncture and treatment cost, and secondary outcomes were self-reported mental distress and adverse events. RESULTS Of 6406 citations, this network meta-analysis included 27 studies including 3416 participants; the mean age was 31.5 years, and 57% were men. Among the five types of acoustic stimulations, only musical interventions, such as music medicine (patient selected) (standardised mean difference (SMD) -0.44 (95% CI: -0.84 to -0.03); low confidence), music medicine (researcher selected) (SMD -0.76 (95% CI: -1.10 to -0.42); low confidence) and music therapy (SMD -0.79 (95% CI: -1.44 to -0.14); low confidence), were associated with improved pain relief during venipuncture compared with no treatment. No significant differences existed between the types of acoustic stimulations. Free-of-charge acoustic stimulations were provided to patients, and no specific adverse events were reported. In many studies, the risk of bias was rated high because of the difficulty of blinding the intervention to the participants and the self-reported pain outcome. CONCLUSIONS Music interventions were associated with reduced venipuncture pain. Comparisons between types of acoustic stimulations revealed no significant differences. Therefore, music intervention could be a safe and inexpensive pain relief method for venipuncture. PROSPERO REGISTRATION NUMBER CRD42022303852.
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Affiliation(s)
- Yosuke Yamada
- Department of Nephrology, Shinshu University Hospital, Matsumoto, Japan
- Department of Nephrology, Aizawa Hospital, Matsumoto, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Emi Inayama
- Department of Nephrology, Mihama Narita Clinic, Chiba, Japan
| | | | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Koto, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tatsuyoshi Ikenoue
- Graduate School of Medicine /Human Health Science, Kyoto University, Kyoto, Japan
- Data Science and AI Innovation Research Promotion Center, Shiga University, Hikone, Japan
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Babaie S, Charkhpour M, Kouhsoltani M, Hamishehkar H, Paiva-Santos AC. Nano-invasomes for simultaneous topical delivery of buprenorphine and bupivacaine for dermal analgesia. Exp Dermatol 2023; 32:1459-1467. [PMID: 37283479 DOI: 10.1111/exd.14850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
Opioid and local anaesthetic receptors are abundantly concentrated in different layers of the skin. Therefore, simultaneous targeting of these receptors can produce more potent dermal anaesthesia. Herein, we developed lipid-based nanovesicles for the co-delivery of buprenorphine and bupivacaine to efficiently target skin-concentrated pain receptors. Invasomes incorporating two drugs were prepared by ethanol injection method. Subsequently, the size, zeta potential, encapsulation efficiency, morphology, and in-vitro drug release of vesicles were characterized. Ex-vivo penetration features of vesicles were then investigated by the franz diffusion cell on the full-thickness human skin. Wherein, it was demonstrated that invasomes penetrated the skin deeper and delivered bupivacaine more effectively than buprenorphine to the target site. The superiority of invasome penetration was further evidenced by the results of ex-vivo fluorescent dye tracking. Estimation of in-vivo pain responses by the tail-flick test revealed that compared with the liposomal group, the group receiving invasomal formulation and drug-free invasomal formulation (only containing menthol) displayed increased analgesia in the initial times of 5 and 10 min. Also, no signs of oedema or erythema were observed in the Daze test in any of the rats receiving the invasome formulation. Finally, ex-vivo and in-vivo assays demonstrated efficiency in delivering both drugs into deeper layers of skin and exposing them to the located pain receptors, which improves the time of onset and the analgesic effects. Hence, this formulation appears to be a promising candidate for tremendous development in the clinical setting.
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Affiliation(s)
- Soraya Babaie
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Charkhpour
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Kouhsoltani
- Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamed Hamishehkar
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ana Cláudia Paiva-Santos
- Department of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy of the University of Coimbra, University of Coimbra, Coimbra, Portugal
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Nazer S, Bhat S, Ramakrishna R, Vasudevarao SB. Comparative Study of the Effectiveness of Vapocoolant Spray Versus EMLA Cream in Reducing Pain During Intravenous Cannulation in the Adult Population. Anesth Pain Med 2023; 13:e136404. [PMID: 38021332 PMCID: PMC10664170 DOI: 10.5812/aapm-136404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/15/2023] [Accepted: 05/29/2023] [Indexed: 12/01/2023] Open
Abstract
Background Intravenous cannulation is a prerequisite before any major or minor surgical procedures. Objectives The rationale of the study was to compare the effectiveness of eutectic mixtures of local anesthetics (EMLA) cream and vapocoolant spray for pain reduction during intravenous (I.V.) cannulation. Methods This observational prospective cohort study was done on 140 patients requiring I.V. cannulation prior to elective procedure who were divided into two groups, including group E: EMLA (eutectic mixtures of local anesthetics) cream and group V: Vapocoolant spray (ethyl chloride). Visual Analogue Scale (VAS) score, hemodynamic variables, and cost analysis were studied between the two groups. Statistical analyses were done using Mann-Whitney U test, unpaired t-test, Fisher's exact test, and chi-square test were used to identify variation in pain scores between the two groups. Post hoc analysis was done at different time points by the Bonferroni test. P-value < 0.05 was considered statistically significant. Results It was observed that the groups were comparable in terms of age, sex, and American Society of Anesthesiologists (ASA) physical status. A highly significant difference was observed between the two groups in terms of VAS scores for pain. There was also a significant difference in terms of heart rate and movement of hands during cannulation between the two groups. No changes were observed in the other hemodynamic parameters. Vapocoolant spray was also more cost-effective compared to EMLA cream with an occlusive dressing. Conclusions Vapocoolant spray was a better tool compared to EMLA cream for intravenous cannulation, especially in emergency settings.
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Affiliation(s)
- Sisla Nazer
- Department of Anaesthesiology, Kasturba Medical College, Mangalore, Manipal Academy Of Higher Education, Manipal, India
| | - Sonal Bhat
- Anaesthesiology Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ranjan Ramakrishna
- Anaesthesiology Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Sunil Baikadi Vasudevarao
- Anaesthesiology Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, India
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Tüzün Özdemir S, Akyol A. Effect of inhaler and topical lavender oil on pain management of arteriovenous fistula cannulation. J Vasc Access 2023; 24:465-474. [PMID: 34396816 DOI: 10.1177/11297298211031086] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The recurrent arteriovenous fistula (AVF) intervention in the treatment of hemodialysis induces pain in patients. Lavender oil has analgesic, antimicrobial, and calming effects. This oil is widely used in patients to reduce anxiety and stress associated with pain caused by analgesics. METHOD The present study is a randomized controlled and experimental clinical trial in which patients (n = 90) who underwent hemodialysis with AVFs were randomly divided into three groups. The intensity of pain was measured in all patients at three different stages during the insertion of arterial needles for hemodialysis: (1) The topical application of 100% lavender essential oil, (2) the inhaler application of 100% lavender essential oil, and (3) no intervention. The placebo (water) was applied to groups 1 and 2. RESULTS Our findings revealed that the mean pre-application pain scores in hemodialysis patients were 57.58 ± 20.28 in the working group, 48.53 ± 20.23 in the control group, 19.49 ± 15.66 in the post-application group, and 45.33 ± 25.52 in the control group (p < 0.005). The average pain scores after the application of lavender oil were 22.66 ± 15.35 in the inhaler lavender group, 16.33 ± 15.97 in the topical lavender group, and 45.33 ± 25.52 in the control group. CONCLUSIONS After inhaler and topical application of lavender oil, a significant decrease in the severity of pain was recorded for patients at the time of arterial insertion of needles.
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Affiliation(s)
| | - Asiye Akyol
- Department of Internal Medicine Nursing, Ege University, Faculty of Nursing, Izmir, Turkey
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Khosravi Pour A, Hejazi S, Kameli A, Hoseini Azizi T, Armat MR, Eshghi M. Cooling spray or lidocaine spray and needle insertion pain in hemodialysis patients: an open-label cross-over randomized clinical trial. BMC Anesthesiol 2023; 23:69. [PMID: 36882711 PMCID: PMC9990356 DOI: 10.1186/s12871-023-02028-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The needle insertion pain to perform hemodialysis is the main challenge and a common problem that requires pain management techniques for patients' comfort. AIM This study aimed to compare the effects of cooling and lidocaine sprays on needle insertion pain in hemodialysis patients. METHODS In this randomized cross-over clinical trial study, the hemodialysis patients were selected through convenience sampling according to inclusion criteria and randomly assigned to three intervention groups using the block randomization method. Each patient received three interventions in a cross-over design: Cooling spray or 10% lidocaine spray or placebo spray. There was a 2-week wash-out time between each intervention. The pain score was measured four times for each patient by the Numerical Rating Scale. RESULTS Forty-one hemodialysis patients were included. The results showed a significant interaction between time and group (p < 0.05), so only observations of time 1 with adjustment for baseline values were used to evaluate the effect of the intervention. Patients receiving cooling spray reported 2.29 less pain score on average compared to placebo (B=-2.29, 95% CI: -4.17 to -0.43; p < 0.05); Also, patients receiving cooling spray reported a 1.61 lower pain score than those receiving lidocaine spray, but this difference was not statistically significant (95% CI: -0.26 to 3.48; p > 0.05). CONCLUSION The cooling spray was effective in reducing the needle insertion pain. Although it was impossible to compare the pain scores at different times and following different interventions, the present study results can help supplement the existing knowledge regarding cooling and lidocaine sprays.
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Affiliation(s)
- Armin Khosravi Pour
- Student Research Committee, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sima Hejazi
- Department of Nursing, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Shahriar Street, Bojnurd, Iran.
| | - Ahmad Kameli
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Tooba Hoseini Azizi
- Department of Nursing, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Shahriar Street, Bojnurd, Iran
| | - Mohammad Reza Armat
- Department of Nursing, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Shahriar Street, Bojnurd, Iran
| | - Maesoomeh Eshghi
- Student Research Committee, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Lee K, Kim D, Lee H, Lee E. The effect of using vapocoolant spray for pain reduction in arteriovenous fistula cannulation among patients undergoing hemodialysis: A randomized control trial. Appl Nurs Res 2023; 71:151674. [PMID: 37179066 DOI: 10.1016/j.apnr.2023.151674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 02/25/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
AIM The aim of this study was to assess the effects of alkane vapocoolant spray in reducing pain during arteriovenous access cannulation in adult patients undergoing hemodialysis. BACKGROUND Developing and applying various approaches for pain relief remain important responsibility for nurses. METHODS This study was designed as an experimental study with a cross-over design. Thirty-eight patients on hemodialysis volunteered to undergo cannulation of their arteriovenous access, after the application of vapocoolant or placebo spray or no intervention. Subjective and objective pain levels were assessed, along with various physiological parameters pre- and post-cannulation. RESULTS Statistically significant between-group differences were observed in subjective pain at the venous (F = 4.97, p = 0.009) and arterial (F = 6.91, p = 0.001) puncture sites. The mean arterial site subjective pain scores were 4.45 ± 1.31 (no treatment), 4.04 ± 1.82 (placebo), and 2.98 ± 1.53 (vapocoolant spray). Significant between-group differences were observed in objective pain scores during arteriovenous fistula puncture (F = 5.13, p = 0.007). The mean objective pain scores after arteriovenous fistula puncture were 3.25 ± 2.66 (no treatment), 2.17 ± 1.76 (placebo), and 1.78 ± 1.66 (vapocoolant spray). Post-hoc test results indicated vapocoolant spray application was associated with significantly lower pain scores than no treatment or placebo. Patient blood pressure and heart rate recordings did not differ among the interventions. CONCLUSION Vapocoolant application was significantly more effective than the placebo or no treatment in reducing the pain of cannulation in adult patients undergoing hemodialysis.
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Wang L, Fang L, Zhou Y, Fang X, Liu J, Qu G. Efficacy and safety of vapocoolant spray for vascular puncture in children and adults: A systematic review and meta-analysis. PLoS One 2023; 18:e0279463. [PMID: 36780438 PMCID: PMC9925002 DOI: 10.1371/journal.pone.0279463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/07/2022] [Indexed: 02/15/2023] Open
Abstract
OBJECTIVE The aim was to evaluate the effectiveness and safety of the vapocoolants for vascular puncture in children and adults. METHOD The search was carried out in PubMed, Web of Science, Embase and The Cochrane Library, from inception to March 2022. Randomized controlled trials comparing vapocoolants to control conditions for participants received intravenous cannulation or arterial puncture were included. Two reviewers independently performed selection of studies, data extraction, and assessment of risk of bias. The analysis was performed using fixed or random-effects model with mean differences or standardized mean difference and risk ratios. RESULTS A total of 25 studies involving 3143 participants were included. Compared with control conditions, vapocoolants may not decrease the pain of patients with arterial puncture (SMD = -0.36, 95% CI = -0.92 to -0.19, P = 0.20), but may more effectively relieve pain for adults received vein puncture (SMD = -0.65, 95% CI = -0.85 to -0.45, P < 0.00001). The application of vapocoolant increased the procedural difficulty of medical personnel (RR = 2.49, 95% CI = 1.62 to 3.84, P<0.000 1) and participants were more willing to use the spray in the future (RR = 1.88, 95% CI = 1.34 to 2.64, P = 0.0002). There was no significant difference for the first attempt success rate of the procedure and the occurrence of adverse events. CONCLUSIONS Vapocoolant spray may relieve pain in adults received vein puncture and cannot cause severe side effects, but is ineffective in children. It also had no effect on patients with arterial puncture. In addition, the application of spray increases procedural difficulties for medical professionals, but does not decrease first attempt success rate, and many patients would like to use the spray again for pain relief in the future. Thus, more rigorous and large-scale studies are needed to determine its effectiveness in vascular access.
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Affiliation(s)
- Lan Wang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Liu Fang
- School of Nursing, Weifang Medical University, Weifang, China
| | - Yang Zhou
- School of Nursing, Weifang Medical University, Weifang, China
| | | | - Jiang Liu
- School of Nursing, Weifang Medical University, Weifang, China
| | - Guiyu Qu
- School of Nursing, Weifang Medical University, Weifang, China
- * E-mail:
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12
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Shaheen S, Arshad AR, Khattak MAK. Comparison of prilocaine/lidocaine cream with piroxicam gel for reducing pain during cannulation of arteriovenous fistula for adults undergoing haemodialysis: A randomized crossover clinical trial. J Vasc Access 2022:11297298221142375. [PMID: 36573703 DOI: 10.1177/11297298221142375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Pain is a traumatic experience for most patients on hemodialysis. In this trial, we compared prilocaine/lidocaine cream with piroxicam gel for pain reduction during arteriovenous fistula needling. METHODS This randomized double-blind crossover clinical trial was done at dialysis unit of a tertiary care hospital from June to August 2022. Adult patients, aged 18-75 years, on maintenance hemodialysis through an arteriovenous fistula were selected randomly. Pain severity during needling of fistula was assessed during initial two hemodialysis sessions without application of any drug. Patients were then randomized into two groups receiving 5% prilocaine/lidocaine cream or 0.5% piroxicam gel 1 h before the next two hemodialysis sessions. After a 7-day washout period, patients crossed over to other groups for another two hemodialysis sessions. Pain was assessed on all these occasions. Primary outcome was reduction in pain with each intervention. RESULTS There were 32 patients aged 46.44 ± 11.58 years. Pain intensity was 6.69 ± 0.58, 3.13 ± 1.28, and 4.55 ± 1.95 without any medication, prilocaine/lidocaine cream and piroxicam gel respectively. There was greater pain reduction with prilocaine/lidocaine cream than piroxicam gel (3.56 ± 1.35 vs 2.14 ± 1.78; p = 0.001). Local redness with prilocaine/lidocaine cream was reported by one (3.13%) patient, whereas no side effects were seen with piroxicam gel (p = 1.000). CONCLUSION Prilocaine/lidocaine cream provides better pain relief than piroxicam gel during arteriovenous fistula needling.
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Affiliation(s)
- Samia Shaheen
- Department of Medicine, Combined Miliary Hospital Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Abdul Rehman Arshad
- Department of Nephrology, Combined Miliary Hospital Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Demirağ H, Hintistan S, Bulut E. The effect of topically administered lavender aromatherapy on the pain of insulin injection in diabetic patients: a double-blind randomized controlled clinical trial. Turk J Med Sci 2022; 52:1845-1853. [PMID: 36945997 PMCID: PMC10390202 DOI: 10.55730/1300-0144.5531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Needle phobia occurs in more than half of diabetic patients due to the pain caused by frequent insulin injections. Therefore, this study evaluated the effect of topically administered lavender aromatherapy on the pain of insulin injections in diabetic patients. METHODS In this double-blind randomized controlled and experimental study, patients who met the study criteria were divided into three groups; topical lavender oil (n = 60), placebo (n = 60), and control (n = 60) groups. The data were collected using the "Patient Information Form", the "Follow-up Form", the "Verbal Category Scale (VCS)", and the "Visual Analogue Scale (VAS)". RESULTS The results revealed no significant difference between the patients in the topical lavender oil group before and during the insulin injection in terms of VAS and VCS pain scores (p > 0.05). In the placebo and control groups, the mean VAS and VCS pain scores during insulin injection were found to be significantly higher than before insulin injection (p < 0.05). Besides, the mean VAS and VCS scores during insulin injection were significantly higher in the placebo and control groups than the topical lavender oil group (p < 0.05). DISCUSSION : The study showed that patients who were administered topical lavender oil felt less pain after insulin injection than those in the placebo and control groups. Therefore, topically applied lavender aromatherapy can be easily used for pain control in insulindependent diabetic patients (clinical trial number NCT04767737).
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Affiliation(s)
- Hatice Demirağ
- Department of Medical Services and Techniques, Kelkit Sema Doğan Vocational School of Health Services, Gümüşhane University, Gümüşhane, Turkey
| | - Sevilay Hintistan
- Department of Nursing, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey
| | - Enes Bulut
- Department of Emergency Aid and Disaster Management, Faculty of Health Sciences, Artvin Çoruh University, Artvin, Turkey
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Inayama E, Yamada Y, Kishida M, Kitamura M, Nishino T, Ota K, Takahashi K, Shintani A, Ikenoue T. Effect of Music in Reducing Pain during Hemodialysis Access Cannulation: A Crossover Randomized Controlled Trial. Clin J Am Soc Nephrol 2022; 17:1337-1345. [PMID: 36002178 PMCID: PMC9625091 DOI: 10.2215/cjn.00360122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Pain during cannulation for vascular access is a considerable problem for patients with kidney disease who are undergoing hemodialysis. We examined whether listening to music can reduce cannulation pain in these patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a multicenter, single-blind, crossover, randomized trial of 121 patients who reported pain during cannulation for hemodialysis. We compared participants listening to "Sonata for Two Pianos in D Major, K.448" or white noise as control while undergoing the cannulation procedure. The cannulation operator was blinded to the intervention, and the hypothesized superiority of music over white noise was concealed during explanations to the participants. The primary end point was the visual analog scale score for cannulation pain independently evaluated by participants. RESULTS The primary analysis was on the basis of the modified intention-to-treat principle. The median baseline visual analog scale pain score was 24.7 mm (interquartile range, 16.5-42.3). Median change of the visual analog scale pain score from the "no sound" to the music period was -2.7 mm (interquartile range, -9.2 to 3.6), whereas it was -0.3 mm (interquartile range, -5.8 to 4.5) from "no sound" to white noise. The visual analog scale pain score decreased when listening to music compared with white noise. (Adjusted difference of visual analog scale pain score: -12%; 95% confidence interval, -21 to -2; P=0.02.) There were no significant differences in the secondary outcomes of anxiety, BP, or stress assessed by salivary amylase (adjusted difference of visual analog scale anxiety score -8%, 95% confidence interval, -18 to 4; P=0.17). No intervention-related adverse events were reported. CONCLUSIONS Listening to music reduced cannulation pain in patients on hemodialysis, although there was no significant effect on anxiety, BP, or stress markers.
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Affiliation(s)
| | - Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, Nagano, Japan
| | - Masatsugu Kishida
- Division of Nephrology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Keiko Ota
- Center for Clinical Research and Innovation, Osaka Metropolitan University Hospital, Osaka, Japan
| | - Kanae Takahashi
- Department of Biostatistics, Hyogo College of Medicine, Hyogo, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Science, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Data Science and AI Innovation Research Promotion Center, Shiga University, Shiga, Japan
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Babamohamadi H, Ameri Z, Asadi I, Asgari MR. Comparison of the Effect of EMLA™ Cream and the Valsalva Maneuver on Pain Severity during Vascular Needle Insertion in Hemodialysis Patients: A Controlled, Randomized, Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:8383021. [PMID: 36091600 PMCID: PMC9451986 DOI: 10.1155/2022/8383021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Background Pain due to vascular needle insertion has been reported in 40-60% of hemodialysis (HD) patients. Evidence suggests that there is typically no single method for relieving the pain of inserting vascular needles in HD patients. This study aimed to compare the effectiveness of EMLA cream and Valsalva maneuver (VM) on pain severity during vascular needle insertion in HD patients. Methods This randomized, controlled, clinical trial was conducted on 90 patients undergoing hemodialysis in the hemodialysis unit of Kowsar Hospital, affiliated with Semnan University of Medical Sciences, in Semnan, Iran. Patients were selected via convenience sampling and were randomly assigned to one of the three groups (EMLA, VM, and control groups). For the patients in the EMLA group, 2.5 g of EMLA cream was applied 60 minutes before the start of dialysis. For patients in the VM group, a maneuver was performed for 16-20 seconds before the needle was inserted. Patients in the control group received only routine care without any additional interventions. The pain severity in the three groups was measured using the visual analog scale (VAS) two minutes after vascular needle insertion. Results The results showed that the mean pain severity during cannulation was 2.06 ± 2.19 in the EMLA group, 3.2 ± 30.42 in the VM group, and 6.20 ± 1.49 in the control group, suggesting a significant difference between the groups (P < 0.001). Pairwise comparison of the mean pain severity showed that it differed significantly in the EMLA and VM groups from the control group (P < 0.001), but no significant difference was found between the EMLA and VM groups (P=0.067). Conclusion According to the results, EMLA cream was as effective as VM in reducing the pain severity caused by arteriovenous fistula (AVF) cannulation. Therefore, the use of EMLA cream and VM is recommended for reducing the severity of AVF cannulation pain. Trial Registration. Iranian Registry of Clinical Trials, Trial No : IRCT20120109008665N12, registered on 3 June 2020.
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Affiliation(s)
- Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan 3513138111, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan 3513138111, Iran
| | - Zahra Ameri
- Student Research Committee, Semnan University of Medical Sciences, Semnan 3513138111, Iran
| | - Ilia Asadi
- Student Research Committee, Semnan University of Medical Sciences, Semnan 3513138111, Iran
| | - Mohammad Reza Asgari
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan 3513138111, Iran
- Department of Nursing, Faculty of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan 3513138111, Iran
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16
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Ibrahim R, Naim M, Premtim R. Evaluation of the pain scale during arteriovenous fistula puncture with and without lidocaine gel 2% in patients undergoing haemodialysis in Kosovo. Ann Med Surg (Lond) 2022; 79:103913. [PMID: 35860101 PMCID: PMC9289220 DOI: 10.1016/j.amsu.2022.103913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/15/2022] Open
Abstract
Aim this study aims to evaluate the pain scale during Arteriovenous fistula (AVF) puncture in patients undergoing regular haemodialysis sessions with and without Lidocaine gel 2%. Methods The study is Cross-Sectional, conducted at the University Clinical Centre of Kosovo - Clinic of Nephrology and Haemodialysis in Pristina, Regional Haemodialysis Centre in Prizren, Regional Haemodialysis Centre in Gjilan and Regional Haemodialysis Centre in Mitrovica, all in Kosovo. In this research, 616 patients were surveyed during AVF puncture and the other group of 232 patients in whom 2% Lidocaine gel was applied before puncture at the fistula puncture site. Results In the above mentioned centres, the total number of patients who are on dialysis through AVF is 632, of which 324 men and 308 women. 560 patients had created AVF on the left arm and 72 patients on the right arm. In our research, 616 patients were surveyed, of which 312 men and 304 women. The most affected age group was between 60 and 69. The pain scale reported during AVF punctuation was moderate in 304 (49%) patients, severe in 176 patients (29%) and mild in 136 (22%) patients. After the applying of Lidocaine gel 2%, the puncture of AVF was performed, so from the total number of 232 participants, 64 (28%) of them reported moderate pain and 168 (72%) of research participants reported mild pain during puncture of AVF. In order to compare results from both groups, we have chosen a random sample from the first group during AVF punctuation without Lidocaine gel 2% (234 in total from 616 patients) and compared the result with the second group during AVF puncture with Lidocaine gel 2% (232 in total). Conclusions The average pain scale during AVF puncture without Lidocaine gel 2% was 5.04 while the average pain scale after applied Lidocaine gel 2% was 2.61. Pain scale 0–10, for patients undergoing the procedure without Lidocaine gel 2%. Pain scale 0–6 (no one from 7 to 10), for patients undergoing the procedure with Lidocaine gel 2%. The average pain 5.04 in patients without the application of Lidocaine gel 2%. The average pain 2.61 in patients with the application of Lidocaine gel 2%. Male are most affected gender in haemodialysis and had AVF fistula.
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Affiliation(s)
- Rudhani Ibrahim
- University of Prishtina “Hasan Prishtina”, Prishtina, Republic of Kosovo
- Clinic of Nephrology and Haemodialysis UCCK Kosovo Hospital Circle N.n, 10000, Pristina, Republic of Kosovo
| | - Morina Naim
- University of Prishtina “Hasan Prishtina”, Prishtina, Republic of Kosovo
- Clinic of Nephrology and Haemodialysis UCCK Kosovo Hospital Circle N.n, 10000, Pristina, Republic of Kosovo
| | - Rashiti Premtim
- University of Prishtina “Hasan Prishtina”, Prishtina, Republic of Kosovo
- Corresponding author.
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Trinder R, Humm K, Phillips S, Cole L. The efficacy of vapocoolant spray for the improved tolerance of catheter pain in emergency patients. J Small Anim Pract 2022; 63:590-596. [PMID: 35508699 DOI: 10.1111/jsap.13504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/22/2022] [Accepted: 03/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to determine if dogs and cats presenting as an emergency had improved tolerance of intravenous catheterisation following the application of vapocoolant spray when compared to a saline control. MATERIALS AND METHODS A randomised controlled trial of client-owned dogs and cats presenting as an emergency and requiring intravenous catheterisation was performed. Patient signalment and mentation score were recorded. All animals were restrained and had their fur clipped over the catheterisation site. They were then randomly allocated to either have a swab saturated with vapocoolant spray (treatment) or a swab saturated with saline (control) applied to the clipped area before intravenous catheterisation. The procedure was video recorded and a single blinded observer reviewed the recordings and assigned reaction scores (0 to 3) at four time points (initial restraint, limb handling, swab application and skin puncture). RESULTS Between October 2020 and January 2021, a total of 100 patients (79 dogs, 21 cats) were enrolled, with 50 in each group. No significant difference in species, age, breed, sex or mentation score was detected between the two groups. There was no significant difference in reaction scores between the groups at any time point with the exception of a significantly increased swab application reaction score in the treatment group compared to the control group. CLINICAL SIGNIFICANCE The indirect application of vapocoolant spray via a swab before catheterisation does not significantly reduce the reaction of dogs and cats to intravenous catheterisation in an emergency setting.
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Affiliation(s)
- R Trinder
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - K Humm
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - S Phillips
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
| | - L Cole
- Department of Clinical Science and Services, The Royal Veterinary College, University of London, Hertfordshire, UK
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Saechoen D, Songthamwat S, Manosomrit T, Chinsri N, Summart U, Songthamwat M. Comparison of pain-reducing effect between topical ethyl chloride spray versus subcutaneous 1% lidocaine injection during two rods system contraceptive implant insertion: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol X 2022; 14:100145. [PMID: 35141517 PMCID: PMC8814373 DOI: 10.1016/j.eurox.2022.100145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 01/12/2022] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Alternative analgesic method during two rods system contraception. Differences between each analgesic methods in two rods system contraception. Efficacy of ethyl chloride spray during two rods system contraception.
Objective To compare the effectiveness of topical ethyl chloride spray (ECS) and subcutaneous 1% lidocaine injection (LI) to reduce pain during the two rods system insertion. Materials and methods One hundred and ten women, who underwent two rods contraceptive implant insertion during January 2021 to July 2021, were enrolled and randomly allocated to ECS and 1% LI groups. After the skin was sterilized, the assigned anesthetic method was administered before insertion of two rods contraceptive implant using the standard procedure. Pain levels during; (1) the administering of the anesthetic, (2) the insertion of the implant, (3) at 20 min after insertion and (4) overall pain levels, were evaluated, using a 10 levels visual analogue scale (VAS). Results All basic clinical characteristics between the two groups showed no significant difference. Mean VAS during anesthetic in the ECS group were significantly lower than in the LI group (3.92 and 2.89, mean difference −1.03, 95%CI −1.76 to −0.31, p < 0.01). However, the mean VAS during; (1) implant insertion, (2) 20 min after implant insertion and (3) overall pain, in the ECS group were significantly higher than in the LI group (4.83, 1.61, 3.11 versus 0.98, 0.09, 1.66) (mean difference 3.85, 1.52, 1.44 (95%CI 3.12 – 4.58, 1.13 – 1.92, 0.97 – 1.92, p < 0.01)). Conclusion ECS should not be used solely as an anesthetic option for the two rods system of implant insertion. It provides for less pain during the administering of the anesthetic but significantly less analgesic effect than LI.
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Affiliation(s)
- Decha Saechoen
- Department of Obstetrics and Gynecology, UdonThani Hospital, UdonThani, Thailand
| | - Srisuda Songthamwat
- Department of Obstetrics and Gynecology, UdonThani Hospital, UdonThani, Thailand
| | | | - Nitaya Chinsri
- Department of Nursing, UdonThani Hospital, UdonThani, Thailand
| | | | - Metha Songthamwat
- Department of Obstetrics and Gynecology, UdonThani Hospital, UdonThani, Thailand
- Correspondence to: Department of Obstetrics and Gynecology, UdonThani Hospital, 33 Po Niyom Road, Mueang Udon Thani District, Udonthani 41000, Thailand.
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Thind D, Roberts SJ, van der Griend BF. Coolsense® versus EMLA® for peripheral venous cannulation in adult volunteers: A randomised crossover trial. Anaesth Intensive Care 2021; 49:468-476. [PMID: 34772301 DOI: 10.1177/0310057x211039227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peripheral venous cannulation (PVC) is a commonly performed invasive medical procedure. Topical treatments such as the eutectic mixture of local anaesthetics (EMLA®, Aspen Pharmacare Australia Pty Ltd, St Leonards, NSW) attenuate the associated pain, but are limited by requiring up to one hour of application before becoming effective. The Coolsense® (Coolsense Medical Ltd., Tel Aviv, Israel) pain numbing applicator is a new device using a cryoanalgesic means to anaesthetise skin within seconds. Coolsense is being increasingly used for cannulation, but comparative studies are lacking. We recruited 64 healthy adult volunteers to this open-label two sequence, two period randomised crossover trial. Participants had two 20 gauge venous cannulae inserted, one on the dorsum of each hand. Each cannulation attempt was preceded by treatment with Coolsense or an EMLA patch containing 2.5% lidocaine and 2.5% prilocaine. The primary outcome was participant pain using the 0-10 numerical pain rating scale. Secondary outcomes were participant satisfaction scores on a 0-10 scale, treatment preference, and failed cannulation attempts. Participants were randomly assigned to either the Coolsense EMLA (n = 32) or EMLA Coolsense (n = 32) sequence. All participants completed the trial. The pooled mean paired difference of the numerical pain rating scale was -1.84 (95% confidence intervals -1.28 to -2.41; P < 0.001) in favour of EMLA. The pooled mean paired difference for satisfaction score was 2.26 (95% confidence intervals 1.46 to 3.07; P < 0.001) higher with EMLA. Most participants preferred EMLA over Coolsense (P < 0.001). There was no significant difference regarding failed cannulation between the two treatments (P = 0.14). Among healthy individuals undergoing elective PVC, EMLA was associated with reduced pain, increased satisfaction, and was the preferred treatment compared to Coolsense.
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Affiliation(s)
- Dilraj Thind
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Stephen J Roberts
- Department of Anaesthesia, 67587Christchurch Hospital, Christchurch Hospital, Christchurch, New Zealand
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Gonella S, Clari M, Conti A, Simionato L, Tassone C, Berchialla P, Campagna S. Interventions to reduce arterial puncture-related pain: A systematic review and meta-analysis. Int J Nurs Stud 2021; 126:104131. [PMID: 34922220 DOI: 10.1016/j.ijnurstu.2021.104131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Arterial puncture-related pain remains unaddressed across several clinical settings. Analgesic techniques are not routinely employed before arterial puncture despite the recommendation that local anesthesia be used, except in emergencies. A comprehensive review of interventions aimed at reducing arterial puncture-related pain and their potential effectiveness is lacking, and the benefit of some interventions is uncertain. OBJECTIVE To describe interventions aimed at reducing arterial puncture-related pain and provide an estimate of their effectiveness. DESIGN Systematic review and meta-analysis (PROSPERO no. CRD42020212299). DATA SOURCE(S) PubMed, CINAHL EBSCO, EMBASE, the Cochrane Database of Systematic Reviews, and Scopus were searched from their inception to 7 October 2020. No temporal or language limits were applied. METHODS Published, quantitative studies on interventions aimed at reducing arterial puncture-related pain among adults were included. Screening, quality appraisal, and data extraction were undertaken independently by two reviewers. Random effects meta-analyses were performed to assess the association between interventions aimed at reducing arterial puncture-related pain and patients' perceived pain using difference in means (MD) with 95% confidence intervals (CIs). A funnel plot and Egger test were used to assess publication bias. RESULTS The titles and abstracts of the 2446 identified articles were screened, and 43 and 31 studies were finally included in the systematic review and meta-analysis, respectively. Interventions to reduce arterial puncture-related pain included: topical anesthetics (n = 16), cryotherapy (n = 9), local anesthetic infiltration (n = 5), narrower needle gage (n = 5), ultrasound-guided procedure (n = 3), topical anesthetics combined with local anesthetic infiltration (n = 1), iontophoresis using anesthetics (n = 1), engineered blood gas syringe (n = 1), jet injector (n = 1), and local massage (n = 1). Topical anesthetics [MD -0.58, 95% CI -1.00, -0.15], cryotherapy [MD -1.13, 95% CI -1.72, -0.53], and local anesthetic infiltration [MD -1.13, 95% CI -1.72, -0.53] reduced arterial puncture-related pain. No benefit was found for narrower needle gage [MD -0.07, 95% CI -0.86, 0.71] or ultrasound-guided procedure [MD -1.74, 95% CI -3.51, 0.03]. No publication bias was detected. CONCLUSIONS Local anesthetic infiltration provided the greatest pain reduction and should be considered standard practice. Cryotherapy may be a safe, convenient alternative to local anesthetic infiltration. Topical anesthetics had limited benefit, and their lengthy time of onset makes them unsuitable for critical or emergency situations, though they may represent an option when comorbid conditions make cooling impossible. Caution must be used when interpreting these results, given the high risk of bias in the methods of included studies and the heterogeneity across the studies.
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Affiliation(s)
- Silvia Gonella
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Torino, Italy; Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Corso Bramante 88-90, 10126 Torino, Italy
| | - Marco Clari
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Torino, Italy
| | - Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Torino, Italy.
| | - Laura Simionato
- Department of Clinical and Biological Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy
| | - Cristina Tassone
- Department of Clinical and Biological Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Torino, Italy
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21
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Ravanshad Y, Golsorkhi M, Ravanshad S, Azarfar A, Esmaeeli M, Ghodsi A. Analgesia for Pediatric Arteriovenous Fistula Cannulation in Hemodialytic Patients: A Comparison of Lidocaine Gel, Lidocaine Spray, and Needle Plate. Indian J Nephrol 2021; 31:349-352. [PMID: 34584349 PMCID: PMC8443097 DOI: 10.4103/ijn.ijn_151_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 11/04/2022] Open
Abstract
Background Children undergoing hemodialysis (HD) via arteriovenous fistula (AVF) experience approximately 300 painful punctures per year which may lead to non-compliance with HD. This study was conducted to show the effect of local anesthetics on pain perception in AVF cannulation. Methods This randomized clinical trial included 20 children under HD via AVF in Sheikh Children's Hospital Hemodialysis Center in February 2014. The first intervention was conducted as the baseline pain assessment (control), then every patient randomly received all three other interventions: Lidocaine gel, lidocaine spray, and needle plate, before venipuncture. Pain perception was expressed and recorded by patients using the visual analogue scale (VAS). VAS scores were compared, and a P value of <0.05 was considered significant. Results The VAS mean in lidocaine spray state, lidocaine gel state, and needle plate state was respectively 47.87, 51.31, and 49.43, which were significantly less than the control state with the VAS mean of 60.06 (lidocaine spray vs. control P value = 0.001, lidocaine gel vs. control P value = 0.001, and needle plate vs. control P value = 0.003). Conclusion Our study showed that the use of needle plate, lidocaine spray, and lidocaine gel are all equally effective ways in controlling the degree of pain in AVF needling in children undergoing HD.
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Affiliation(s)
- Yalda Ravanshad
- Department of Community Medicine, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Mohaddeseh Golsorkhi
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sahar Ravanshad
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Anoush Azarfar
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Esmaeeli
- Department of Pediatrics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Ghodsi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Effect of Lavender Aromatherapy On Arteriovenous Fistula Puncture Pain and the Level of State and Trait Anxiety in Hemodialysis Patients: A Randomized Controlled Trial. Pain Manag Nurs 2021; 22:509-515. [DOI: 10.1016/j.pmn.2021.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 12/31/2020] [Accepted: 01/23/2021] [Indexed: 11/18/2022]
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Abunab HY, Alzaatreh MY, Abdalrahim MS. Effect of addition of distraction to cryotherapy on arteriovenous cannulation-associated pain: A randomized controlled trial. Hemodial Int 2021; 25:473-478. [PMID: 34133067 DOI: 10.1111/hdi.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/05/2021] [Accepted: 05/23/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pain associated with the arteriovenous fistula needle is considered one of the major challenges faced by nurses and patients. This study evaluates the effectiveness of using two different approaches in combination to alleviate pain associated with arteriovenous fistula needle cannulation, and patients' satisfaction level with this method. METHODS A randomized clinical trial was conducted on hemodialysis patients who were allocated to one to two groups: intervention (distraction plus cryotherapy) (n = 25) or control group (receiving cryotherapy alone) (n = 25). The pain level was assessed before and at the end of applying cryotherapy and distraction techniques. Patients' satisfaction level was assessed at the end of the trial. FINDINGS After the application of cryotherapy and distraction techniques for the intervention group, the mean value of pain level was 2.12 (0.9) compared with 3.92 (0.16) for the control group. Independent t tests showed a significant difference between groups regarding the pain level with p value less than 0.05. The mean satisfaction level for the participants receiving only cryotherapy was 4.6 out of 10, compared with 5.9 for the patients who received cryotherapy and distraction techniques. DISCUSSION The findings revealed that using two different approaches in combination to control pain associated with AV fistula cannulation was more effective than using a single strategy. The technique can be used in clinical settings to reduce pain and improve patients' satisfaction level.
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Tank JC, Georgiadis GM, Bair JM, Rice A, O'Mara Gardner K, Chen JT, Redfern RE. Does The Use of Ethyl Chloride Improve Patient-Reported Pain Scores With Negative Pressure Wound Therapy Dressing Changes? A Prospective, Randomized Controlled Trial. J Trauma Acute Care Surg 2021; 90:1061-1066. [PMID: 33755640 DOI: 10.1097/ta.0000000000003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) is commonly used for surgical incisions and large wounds, particularly in the context of trauma. Research has shown that patients report that the most painful aspect of NPWT is related to foam dressing changes. This study aimed to determine whether topical use of the vapocoolant anesthetic ethyl chloride would impact patient-reported pain during these procedures. METHODS This study was a single-blinded, placebo-controlled randomized trial in patients who were undergoing NPWT foam dressing change following surgery performed by the orthopedic trauma team. A total of 100 patients were randomized to receive ethyl chloride topical anesthetic spray or placebo (tissue culture grade water) during dressing change. The outcome measure specified prior to enrollment was a mean decrease in patient-reported pain of 1.7 points using a numeric rating scale. Baseline and procedural characteristics were collected to investigate contributions to patient-reported pain. We hypothesized that the use of ethyl chloride would decrease patient reported pain scores. RESULTS Significantly more females were randomized to the receive vapocoolant; remaining baseline and procedural characteristics were similar between groups. The median time for NPWT drape removal was 2.0 minutes in both groups (p = 0.66). The postprocedural pain reported by patients was significantly lower in the experimental group compared with placebo (median, 5.0 vs. 7.0; p = 0.03). Multivariate analysis adjusting for potential confounders showed treatment group to be the strongest predictor of postprocedure pain (p = 0.002). Additionally, a generalized linear model suggests that treatment group was the strongest predictor of change in pain score as reported by patients prior to and immediately following dressing change. CONCLUSIONS Use of vapocoolant spray during NPWT dressing change for orthopedic trauma wounds and surgical incisions was feasible and resulted in significant reduction in patient-reported pain associated with the procedure. LEVEL OF EVIDENCE Therapeutic, Level I.
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Affiliation(s)
- Jason C Tank
- From the Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, (J.C.T., G.M.G., J.M.B.), Enterostomal Therapy (A.R.), Department of Orthopaedics (K.O.G.), ProMedica Toledo Hospital, Toledo; Department of Mathematics and Statistics (J.T.C.), Bowling Green State University, Bowling Green, OH; and ProMedica Research (R.E.R.), ProMedica Toledo Hospital, Toledo, Ohio
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25
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Kosmadakis G, Amara I, Costel G. Pain on arteriovenous fistula cannulation: A narrative review. Semin Dial 2021; 34:275-284. [PMID: 33962481 DOI: 10.1111/sdi.12979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pain on arteriovenous fistula (AVF) cannulation is a rather persistent problem in the daily hemodialysis practice. Its prevalence varies from 12% to even 80% depending on the definition and the pain-assessment tools and it affects the quality of life of hemodialysis patients. It is associated with fear of the cannulation process, the decision of hemodialysis from an AVF and sometimes the hemodialysis itself. In this narrative review, we tried to tackle the extent of the problem and to present the available published solutions. The literature suggests a large array of methods based on the application of local anesthetic creams, application of cold or hot directly on the cannulation sites or on the contralateral arm, cannulation techniques and AVF localization, distraction as well as alternative treatments. All of them have shown a relative success. There is a serious lack of large multicenter randomized trials and a gap concerning work groups and guidelines or recommendations from national or international societies on this matter. Complementary training starting from the predialysis patient education programs may be useful. Alternative prophylactic measures including counseling, hypnosis, or other physicochemical interventions could also improve our knowledge on the treatment of this seriously uncomfortable condition.
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26
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Sallée M, Mercadal L, Jean G, Guery B, Borniche D, Charrel JM, Hannedouche T, Roy FL, Brunet P. Vascular access cannulation and haemostasis: a national observational study of French practices. Clin Kidney J 2021; 14:1261-1268. [PMID: 33841870 PMCID: PMC8023177 DOI: 10.1093/ckj/sfaa098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We report the results of an observational study of arteriovenous fistula (AVF) cannulation and haemostasis practices in France. METHODS The study (sponsored by Brothier Pharmaceutical Inc.) was conducted in 150 dialysis units. Data obtained from 150 supervisory nurses, 1538 nurses and 3588 patients with an AVF were analysed. RESULTS The nurses reported using rope-ladder, area or buttonhole cannulation techniques in 68, 26 and 6% of cases, respectively. Metal needles were used most frequently (64%), with mainly a diameter of 15 G or 16 G. The needle was introduced with the bevel up in 56% of cases. Compression applied using dressings (in particular, pure calcium alginate dressings) was the method of choice for haemostasis of the puncture sites and was assessed as being strong by most of the nurses and very strong in cases of prolonged bleeding. Most (82%) of the patients reported the use of local anaesthetic before cannulation and 23% reported an allergic skin reaction to the anaesthetic. Bleeding of the puncture sites lasted for >10 min for 48% of the patients and it reappeared between two sessions for 29% of the patients. Whereas the nurses appeared to have a good understanding of AVF, more than half of the patients did not know how to care for it, with 55% requiring more information. CONCLUSIONS This study underlines the lack of national consensus concerning AVF cannulation practices. It suggests that haemostasis methods of the puncture sites can be improved and it highlights the need to improve patient knowledge.
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Affiliation(s)
- Marion Sallée
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
- C2VN, Aix Marseille Univ, INSERM, INRAE, Marseille, France
| | - Lucile Mercadal
- Department of Nephrology, hôpital universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Bruno Guery
- Department of Nephrology-adult dialysis, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Didier Borniche
- AFIDTN, French Association of Nurses for Dialysis, Transplantation and Nephrology, Bihorel, France
| | | | - Thierry Hannedouche
- Department of Nephrology and Haemodialysis, Hôpitaux Universitaires de Strasbourg & Faculté de Médecine, Strasbourg, France
| | - Frank Le Roy
- Department of Nephrology University, Centre Hospitalier Universitaire de Rouen, France
| | - Philippe Brunet
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Marseille, Hôpital de la Conception, Marseille, France
- C2VN, Aix Marseille Univ, INSERM, INRAE, Marseille, France
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Cheng J, Zhang H, Bao H, Hong H. Music-based interventions for pain relief in patients undergoing hemodialysis: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24102. [PMID: 33466179 PMCID: PMC7808445 DOI: 10.1097/md.0000000000024102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/08/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Music therapy and music-based interventions have been used widely in numerous medical procedures to reduce the physical and psychological disorders. However, the effect of music therapy on pain relief in hemodialysis patients still remains unclear. METHODS Electronic databases were comprehensively searched through MEDLINE, Web of Science, EMBASE, Cochrane, and WANFANG. All studies met inclusion criteria were eligible for systematic review and meta-analysis. Clinical variables were extracted and pooled results were obtained using STATA software. RESULTS A total of 10 studies with 722 participants were included for systematic review. Overall, music therapy showed a significantly favorable effect on reducing pain for patients undergoing hemodialysis (SMD: -0.90, 95%CIs: -1.25 to -0.55, P < .001). No publication bias was observed. CONCLUSIONS Music-based interventions could significantly relieve pain for patients undergoing hemodialysis, which should be promoted as an effective and safe complementary method.
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Affiliation(s)
- Jingru Cheng
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University
| | - Hui Zhang
- Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing
| | - Hong Bao
- Department of General Surgery, Mingguang Hospital of Traditional Chinese Medicine, Mingguang, China
| | - Hanxia Hong
- Department of Urology, The First Affiliated Hospital with Nanjing Medical University
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Barbour T, O'Keefe S, Mace SE. Topical Refrigerant Spray for IVs: Patient/Provider Responses - Prospective, Double-blind, Randomized Study. West J Nurs Res 2020; 43:762-769. [PMID: 33292081 DOI: 10.1177/0193945920976061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Painful procedures are common. Patients prefer analgesia for painful procedures. Studies indicate that use of a topical refrigerant spray (TRS) prior to needlestick procedures decreases needlestick pain. TRS is easy to apply, inexpensive, has fast onset, and avoids needlestick pain and anxiety, and needlestick injury risk. Patient and health care provider (HCP) acceptance of any technique is essential before it is adopted. This study evaluated the decrease in pain with TRS and the patient and HCP satisfaction and acceptance of TRS for peripheral intravenous (PIV) placement. Adults (N = 300) randomized to placebo or TRS and HCPs (N = 300) placing PIVs answered questionnaires. Patients had significantly less pain than with prior PIVs, and were satisfied with and would use TRS in the future (P < 0.001). HCP felt that patients had significantly (P < 0.001) less pain with TRS than the placebo, and were satisfied with the TRS, and would use TRS in the future.Registered at Clinicaltrials.gov NCT01670487.
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Affiliation(s)
- Tracy Barbour
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sharon O'Keefe
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sharon E Mace
- Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, USA.,MetroHealth Medical Center/Cleveland Clinic Emergency Residency, Cleveland, OH, USA
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Abstract
Painful diagnostic and therapeutic procedures are common in the emergency department. Adequately treating pain, including the pain of procedures is an essential component of the practice of emergency medicine. Pain management is also part of the core competency for emergency medicine residencies and pediatric emergency medicine fellowships. There are many benefits to providing local and/or topical anesthesia before performing a medical procedure, including better patient and family satisfaction and increased procedural success rates. Local and topical anesthetics when used appropriately, generally, have few, if any, systemic side effects, such as hypotension or respiratory depression, which is an advantage over procedural sedation. Use of local and topical anesthetics can do much toward alleviating the pain and anxiety of pediatric patients undergoing procedures in the emergency department.
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Comparison of the Effects of Visual and Auditory Distractions on Fistula Cannulation Pain among Older Patients Undergoing Hemodialysis: A Randomized Controlled Clinical Trial. Geriatrics (Basel) 2020; 5:geriatrics5030053. [PMID: 32948045 PMCID: PMC7555170 DOI: 10.3390/geriatrics5030053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022] Open
Abstract
Pain associated with fistula cannulation is a challenge for nurses who provide care to older patients undergoing hemodialysis. Several non-pharmacological methods have been suggested for relieving fistula cannulation pain, but the benefits of visual and auditory distraction methods among older patients undergoing hemodialysis have not been investigated yet. Therefore, this study aimed to compare the effects of visual and auditory distractions on fistula cannulation pain among older patients undergoing hemodialysis. This randomized controlled clinical trial was conducted on 120 older patients undergoing hemodialysis. They were randomly assigned to three groups of visual distraction, auditory distraction, and the control (n = 40 in each group) using a simple random assignment method. The distraction interventions continued for three consecutive sessions and the numeric rating scale of pain severity was used for data collection. Descriptive and inferential statistics were used for data analysis using SPSS. It was found that pain severity significantly reduced after the distraction interventions in either the auditory or visual distraction groups and also after all three distraction sessions (p = 0.001). However, visual distraction had a better effect on the reduction of pain severity. Therefore, while both visual and auditory distractions reduced pain severity in older patients undergoing hemodialysis, visual distraction was more effective. Nurses are encouraged to incorporate visual distraction as a safe and non-pharmacologic technique into routine nursing care for reducing older patients’ suffering and improving their wellbeing when fistula cannulation is performed.
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31
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Reyes MCGM, Reyes MCGM, Ribay KGL, Paragas ED. Effects of sweet orange aromatherapy on pain and anxiety during needle insertion among patients undergoing hemodialysis: A quasi-experimental study. Nurs Forum 2020; 55:425-432. [PMID: 32185802 DOI: 10.1111/nuf.12447] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Patients undergoing hemodialysis experience pain and anxiety during needle insertion, and the scientific interest in aromatherapy in reducing pain and anxiety is increasing. Thus, this study aimed to determine the effects of sweet orange aromatherapy on pain and anxiety during needle insertion in hemodialysis. DESIGN Quasi-experimental, pretest, and posttest. METHODS This study was carried out among 50 patients with chronic kidney disease who were non-randomly assigned to either sweet orange aromatherapy or calm breathing in three outpatient hemodialysis centers in the Philippines between July and August 2015. The numeric rating scale and adapted state-trait anxiety inventory were utilized to measure pain and anxiety. RESULTS After the intervention, both the pain and anxiety scores were significantly lower for patients who received sweet orange aromatherapy than those who received calm breathing. The results obtained modest effect sizes that imply high practical significance. CONCLUSION The sweet orange aromatherapy can be effective in reducing pain and anxiety. Thus, this can be used by nurses as an alternative and complementary approach to reduce both pain and anxiety in painful procedures like needle insertion.
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Affiliation(s)
- Ma Catherine Grace Mendoza Reyes
- College of Nursing, University of Santo Tomas, Manila, Philippines
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | - Ma Corrine Grace Mendoza Reyes
- College of Nursing, University of Santo Tomas, Manila, Philippines
- Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
| | - Krystal Gale Lastrella Ribay
- College of Nursing, University of Santo Tomas, Manila, Philippines
- Department of Nursing, Bicol Regional Training and Teaching Hospital, Legazpi City, Albay, Philippines
| | - Emmanuel Dayao Paragas
- College of Nursing, University of Santo Tomas, Manila, Philippines
- Nursing Department, College of Sciences, West Liberty University, West Liberty, West Virginia
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Perkins SE, Hankenson FC. Nonexperimental Xenobiotics: Unintended Consequences of Intentionally Administered Substances in Terrestrial Animal Models. ILAR J 2020; 60:216-227. [PMID: 32574354 DOI: 10.1093/ilar/ilaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 12/17/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
Review of the use of nonexperimental xenobiotics in terrestrial animal models and the potential unintended consequences of these compounds, including drug-related side effects and adverse reactions.
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Affiliation(s)
- Scott E Perkins
- Tufts Comparative Medicine Services, Tufts University, Boston, Massachusetts; and Department of Environmental and Population Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, Massachusetts
| | - F Claire Hankenson
- Campus Animal Resources, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
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The effects of eugenol nanoemulsion on pain caused by arteriovenous fistula cannulation in hemodialysis patients: A randomized double-blinded controlled cross-over trial. Complement Ther Med 2020; 52:102440. [PMID: 32951708 DOI: 10.1016/j.ctim.2020.102440] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/01/2020] [Accepted: 05/11/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Local anesthetic and antinociceptive activity of eugenol, as the main ingredient of clove, was determined in previous researches. This study aimed to assess the efficacy of its topical nanoemulsion gel vs. placebo in controlling pain caused by arteriovenous fistula (AVF) needling in patients undergoing hemodialysis (HD). DESIGN In this double-blinded cross-over trial, the patients were randomly allocated to eugenol gel 4% (n = 34) and placebo gel (n = 34) groups. For each patient, a tip of finger unit of gel was applied 2 cm around the insertion site of hemodialysis needles. After 10 min, AVF needling was done. AVF needling-related pain was assessed using visual analogue scale (VAS) immediately after the puncture. All patients were tested at three different states: (1) before using any intervention; (2) after using either the eugenol or placebo gel; and (3) after crossing over the groups. RESULTS There was a significant difference between the mean of patients' pain severity score in the three states (p = 0.001). It was reported as low as 3.29 ± 0.67 in patients who received eugenol nanoemulsion. Also, the highest pain severity score (5.03 ± 0.57) was reported at the no-intervention state. CONCLUSIONS It seems that topical application of eugenol nanoemulsion may significantly decrease AVF cannulation related pain intensity score in patients undergoing HD. However, further studies with larger sample size and longer intervention period should be done for better judgment on its efficiency and safety.
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Lv L, Yan L, Liu X, Chen M. Effectiveness of lidocaine/prilocaine cream on cardiovascular reactions from endotracheal intubation and cough events during recovery period of older patients under general anesthesia: prospective, randomized placebo-controlled study. BMC Geriatr 2020; 20:157. [PMID: 32366224 PMCID: PMC7197116 DOI: 10.1186/s12877-020-01567-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endotracheal intubation is known to pose significant physiological, pharmacokinetic, and dynamic changes and postoperative respiratory complications in patients under general anesthesia. METHOD An RCT trial was organized by the Third Affiliated Hospital at Sun Yat-sen University, China. Patients were eligible for inclusion in the trial if they were over 60 years old and had upper-abdominal surgery during the induction of anesthesia and had enrolled in endotracheal intubations. The primary end point included cardiovascular reactions during the induction of anesthesia and endotracheal intubations and cough events during the recovery period. In the test group, 2 g of lidocaine/prilocaine cream (and in the control group, 2 g of Vaseline) were laid over the surface of the tracheal tube cuff. RESULTS The systolic blood pressure (F value = 62.271, p < 0.001), diastolic blood pressure (F value = 150.875, p < 0.001), and heart rate (F value = 75.627, p < 0.001) of the test group were significantly lower than the control group. Cough events during the recovery period in the test group were better (spontaneous cough, χ2 value = 10.591, p < 0.001; induced cough, χ2 value =10.806, p < 0.001). CONCLUSION In older patients, coughing and cardiovascular reactions under anesthesia and endotracheal intubations were reduced, as a result of using lidocaine/prilocaine cream on the surface of the tracheal tube cuff. TRIAL REGISTRATION International Clinical Trials Network NCT02017392, 2013-12-16.
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Affiliation(s)
- Linsheng Lv
- Operation Room, the third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China
| | - Lei Yan
- Shanghai Shyndec Pharmaceutical Co., Ltd, Shanghai, 600420, China
| | - Xun Liu
- Division of Nephrology, the third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China.
| | - Miaoxia Chen
- Nursing Department, the third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong, China.
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Fujimoto K, Adachi H, Yamazaki K, Nomura K, Saito A, Matsumoto Y, Igarashi K, Uranishi H, Sakaguchi S, Matsuura T, Imura J, Okino K, Mukai K, Okushi Y, Kagaya Y, Tsuruyama Y, Okada K, Miyatake N, Haraguchi T, Iida Y, Yokoyama H. Comparison of the pain-reducing effects of EMLA cream and of lidocaine tape during arteriovenous fistula puncture in patients undergoing hemodialysis: A multi-center, open-label, randomized crossover trial. PLoS One 2020; 15:e0230372. [PMID: 32210455 PMCID: PMC7094835 DOI: 10.1371/journal.pone.0230372] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/26/2020] [Indexed: 11/18/2022] Open
Abstract
Arteriovenous fistula puncture pain is a serious problem for patients undergoing dialysis and a good indication for topical anesthetics. No previous study has compared lidocaine/prilocaine cream (EMLA) with lidocaine tape for pain relief during arteriovenous fistula puncture in patients undergoing maintenance hemodialysis. To this end, we conducted a multicenter randomized crossover study including 66 patients (mean age, 65.8 years; males, 57.6%) undergoing maintenance hemodialysis thrice/week. Subjects were assigned to Sequence EL (EMLA administration followed by lidocaine, with 1-week wash-out) or Sequence LE (reverse administration, first lidocaine then EMLA). All subjects completed the study. At each puncture site, 1 g EMLA (25 mg lidocaine + 25 mg prilocaine) or one sheet of lidocaine tape (18 mg lidocaine) was applied 1 h or 30 min prior to arteriovenous fistula puncture, respectively. The primary endpoint was puncture pain relief, which was measured using a 100-mm visual analog scale. The secondary endpoints included quality of life, which was measured by SF-36, and safety. EMLA produced a 10.1-mm greater visual analog scale improvement than lidocaine tape (P = 0.00001). However, there was no statistically significant difference in the quality of life between the two groups, and no significant carryover/period effect was observed in any analysis. Further, no drug-related adverse events were observed. Taken together, these results suggest that EMLA cream is superior to lidocaine tape for the relief of arteriovenous fistula puncture pain in patients undergoing maintenance hemodialysis. Trial registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN000027885).
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Affiliation(s)
- Keiji Fujimoto
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
- * E-mail:
| | - Hiroki Adachi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Kanae Nomura
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Atsushi Saito
- Kanazawa Medical University Himi Municipal Hospital, Toyama, Japan
| | | | | | | | | | - Toshikazu Matsuura
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Kazuaki Okino
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Kiyotaka Mukai
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Yuki Okushi
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Yu Kagaya
- Keiju Medical Center, Ishikawa, Japan
| | - Yuko Tsuruyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Keiichiro Okada
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Nobuhiko Miyatake
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | | | - Yasuo Iida
- Department of Mathematics, Kanazawa Medical University, Ishikawa Japan
| | - Hitoshi Yokoyama
- Department of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
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Bilge S, Aydin A, Gun C, Aldinc H, Acar YA, Yaylaci S, Cinar O, Balci V. Comparison of the efficacy of ShotBlocker and cold spray in reducing intramuscular injection-related pain in adults. A prospective, randomized, controlled trial. Saudi Med J 2020; 40:996-1002. [PMID: 31588477 PMCID: PMC6887882 DOI: 10.15537/smj.2019.10.24322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: To compare the efficacy of ShotBlocker and cold spray in reducing intramuscular (IM) injection-related pain in adults. Methos: A prospective, randomized, controlled study carried out between January 2018 and March 2018 at the Department of Emergency Medicine, Acibadem Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey. Adult patients receiving IM injection of diclofenac sodium (75 mg/3 ml) were included. The patients were randomized into 3 groups: ShotBlocker, cold spray, and control. Each group comprised 40 patients. Patients were instructed to rate the intensity of IM injection-related pain using a 100-mm visual analog scale (VAS). Visual analog scale scores of the patients were statistically analyzed. Results: Visual analog scale scores were lower in the ShotBlocker (11 mm) and cold spray (10 mm) groups than in the control group (31 mm) (p=0.001). There were no significant differences in VAS scores between the ShotBlocker and cold spray groups. The operators’ responses revealed that ShotBlocker was more difficult to administer than cold spray. Conclusion: ShotBlocker is an effective non-pharmacological method that reduces IM injection-related pain and is similar in efficacy, to cold spray.
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Affiliation(s)
- Sedat Bilge
- Department of Emergency Medicine, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey. E-mail.
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Alzaatreh MY, Abdalrahim MS. Management Strategies for Pain Associated with Arteriovenous Fistula Cannulation: An Integrative Literature Review. Hemodial Int 2019; 24:3-11. [DOI: 10.1111/hdi.12803] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/24/2019] [Accepted: 10/29/2019] [Indexed: 11/30/2022]
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Kishida M, Yamada Y, Inayama E, Kitamura M, Nishino T, Ota K, Shintani A, Ikenoue T. Effectiveness of music therapy for alleviating pain during haemodialysis access cannulation for patients undergoing haemodialysis: a multi-facility, single-blind, randomised controlled trial. Trials 2019; 20:631. [PMID: 31744526 PMCID: PMC6862830 DOI: 10.1186/s13063-019-3773-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022] Open
Abstract
Background Repeated pain during haemodialysis access cannulations is a serious problem for haemodialysis patients even when prescribed oral or topical analgesics. Although some studies have observed the efficacy of music therapy for improving pain and anxiety, its effectiveness during haemodialysis access cannulations during dialysis is uncertain. The purpose of this study is to investigate the effects of music therapy for pain when cannulating haemodialysis access for haemodialysis patients. Methods A prospective, multi-facility, single-blind, crossover, randomised controlled trial will be implemented. The intervention includes listening to Mozart, along with a white noise control condition. One hundred twenty haemodialysis patients will be enrolled across five facilities. Patients will be randomly allocated to either an Early-sequence group or a Later-sequence group. The Early-sequence group will receive cannulation while listening to Mozart’s Sonata for two pianos in D major (K.448) during the second week (Music period) and white noise during the fourth week (White noise period). The Later-sequence group will receive cannulation along with white noise first, followed by Mozart. All patients will also undergo cannulation during a no-sound period (wearing only headphones) during the first and third week (No-sound period). The music or no-music protocol will begin 8 min prior to the cannulating procedure, and participants will finish listening after starting haemodialysis during each period. The primary outcomes that will be assessed include the Visual Analogue Scale (VAS) score for pain during cannulation, and secondary outcomes are blood pressure, heart rate, VAS anxiety score, State-Trait Anxiety Inventory score, and salivary amylase activity. The operators who are in charge of haemodialysis access cannulation will be blind to the listening condition and VAS report. Discussion The proposed study has several methodological benefits. First, using white noise is a suitable control condition for addressing the role of sound in pain management. Additionally, using a crossover design with repeated measurements can help control individual differences between participants, which should better distinguish between- and within-participant variability. Overall, music therapy is a safe and inexpensive intervention that does not have the problematic side effects typically associated with pharmacological treatment. If effective, music therapy can be easily implemented for reducing pain and anxiety during cannulation. Trial registration This trial was prospectively registered to UMIN Clinical Trials Registry on 1 July 2018 (UMIN 000032850).
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Affiliation(s)
- Masatsugu Kishida
- Division of Nephrology, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, 564-8565, Japan
| | - Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan
| | - Emi Inayama
- Mihama Narita Clinic, 129-1 Iida-cho, Narita, 286-0041, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Keiko Ota
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Osaka, 545-0051, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-cho, Osaka, 545-0051, Japan
| | - Tatsuyoshi Ikenoue
- Graduate School of Medicine and Public Health, Kyoto University, 53 Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Ghoreyshi Z, Amerian M, Amanpour F, Mohammadpourhodki R, Ebrahimi H. Comparing the effects of cold compress and Xyla-p cream on hemodynamic changes in hemodialysis patients during venipuncture. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 17:/j/jcim.ahead-of-print/jcim-2019-0154/jcim-2019-0154.xml. [PMID: 31513531 DOI: 10.1515/jcim-2019-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/31/2019] [Indexed: 11/15/2022]
Abstract
Background The vital signs reflect the physiological state of patients in various clinical conditions. The purpose of this study was to compare the effects of cold compress and Xyla-P cream on hemodynamical changes during venipuncture in hemodialysis patients. Methods and Material In this clinical trial study, 50 patients under hemodialysis were selected by simple random sampling. The patients were then randomly assigned to either Xyla-P cream, cold compress or placebo groups. The vital signs (blood pressure and pulse) were measured upon two intermittent hemodialysis sessions before and after venipuncture. Data were analyzed using repeated measures analysis of variance. Results The mean alternation in systolic blood pressure was significantly different comparing the placebo and cold compress groups before and after intervention (p<0.001). However, the difference was not significant between the Xyla-P cream group and either placebo (p=0.402) or ice compress (p=0.698) groups. The difference of the mean diastolic blood pressure was significant comparing the placebo group with either the Xyla-P cream group (p=0.003) or cold compress group (p<0.001) before and after intervention. In addition, there was a significant difference in the mean number of heartbeats comparing the control group with either the Xyla-P cream group (p<0.001) or cold compress group (p<0.001) before and after the intervention. Conclusions Considering the beneficial effects of ice compress and the Xyla-P cream on reduction of cardiovascular parameters, it is recommended to use these methods in hemodialysis patients during venipuncture.
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Affiliation(s)
- Ziba Ghoreyshi
- Shohada Hospital, Mashhad University of Medical Sciences, Quchan, Iran (Islamic Republic of)
| | - Monireh Amerian
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran (Islamic Republic of)
| | - Farzaneh Amanpour
- Clinical Research Development Unit, Bahar Hospital, Shahroud University of Medical Sciences, Shahroud, Iran (Islamic Republic of)
| | - Reza Mohammadpourhodki
- Department of Nursing, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hossein Ebrahimi
- Randomized Controlled Trial Research Center, Shahroud University of Medical Sciences, 7th Sq., Shahroud, Iran
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Aihara S, Yamada S, Shichijo S, Fukumitsu K, Kondo M, Hirashima Y, Oka H, Kamimura T, Harada A, Nakano T, Tsuruya K, Kitazono T. Lidocaine-Propitocain Cream, a Eutectic Mixture of Local Anesthetics, Effectively Relieves Pain Associated With Vascular Access Intervention Therapy in Patients Undergoing Hemodialysis: A Placebo-Controlled, Double-Blind, Crossover Study. Ther Apher Dial 2019; 24:34-41. [PMID: 31006955 DOI: 10.1111/1744-9987.12813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/12/2019] [Accepted: 04/18/2019] [Indexed: 12/01/2022]
Abstract
Vascular access intervention therapy (VAIVT) is necessary to maintain vascular access in patients undergoing hemodialysis. VAIVT-associated vasodilatation is painful. However, few reports have focused on effective pain relief at the time of VAIVT. The present study was performed to determine whether lidocaine-propitocain cream, a eutectic mixture of local anesthetics (EMLA), effectively reduces VAIVT-associated pain in patients undergoing hemodialysis. This placebo-controlled, double-blind, crossover study was conducted in a single center. Among 210 patients who underwent a total of 437 VAIVT procedures from August 2017 to June 2018, 30 patients were randomly allocated to either the EMLA-placebo arm or placebo-EMLA arm at the time of VAIVT. EMLA application significantly reduced the visual analog scale score compared with placebo (47.0 ± 21.1 vs. 68.6 ± 20.7 mm, respectively; P < 0.05). EMLA is a safe and effective treatment for relief of VAIVT-associated pain in patients undergoing hemodialysis.
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Affiliation(s)
- Seishi Aihara
- Kidney Center, Matsuyama Red Cross Hospital, Matsuyama, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoru Shichijo
- Kidney Center, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Kento Fukumitsu
- Kidney Center, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Mika Kondo
- Kidney Center, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | | | - Hideaki Oka
- Kidney Center, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Taro Kamimura
- Kidney Center, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Atsumi Harada
- Kidney Center, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Rao PB, Mohanty CR, Singh N, Mund M, Patel A, Sahoo AK. Effectiveness of Different Techniques of Ethyl Chloride Spray for Venepuncture-Induced Pain: A Randomised Controlled Trial. Anesth Essays Res 2019; 13:568-571. [PMID: 31602079 PMCID: PMC6775824 DOI: 10.4103/aer.aer_103_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Venepuncture is an essential component of anaesthesia services. However, this invites pain generating the first negative experience with anaesthesia. Hence, relief of this pain carries considerable importance. Efficacy of ethyl chloride spray although studied, there is no consensus for the best way of application. Objectives: The present study was conducted to find an effective technique/method of ethyl chloride spray application to reduce venepuncture pain. Methods: Adult patients posted for different anaesthesia procedures were randomised into three groups. Venepuncture was done either after installation of distilled water or spray of ethyl chloride either once to twice. Venepuncture pain was assessed with a 0-100 Numeric Rating Scale. Results: The analysis showed significant differences among the groups (F [2,96] = 66.27, P < 0.05). The twice sprayed group experienced the least pain ([mean ± standard deviation [SD]] 16.67 ± 10.21), lower in the once spray group ([mean ± SD] 27.58 ± 13.24), and the controls had the highest pain score ([mean ± SD] 49.09 ± 11.28). Post hoc Tukey's tests showed all the three groups differed significantly. The effect size was large, and the variability of the spray on the reduction of pain scores is 58% (η2 = 57.99). Conclusion: Ethyl chloride spray effectively reduces the pain on venepuncture, especially when the vapocoolant is sprayed twice each over 5 s, and from a distance of 5 cm perpendicular to the skin.
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Affiliation(s)
- Parnandi Bhaskar Rao
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency (Anaesthesia), All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Neha Singh
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Manisha Mund
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Anamika Patel
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Alok Kumar Sahoo
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Science, Bhubaneswar, Odisha, India
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Abstract
Pain is one of the most common symptoms among patients with end-stage renal disease (ESRD), and is often under recognized and not adequately managed in hemodialysis (HD) patients. Barriers to adequate pain management include poor awareness of the problem, insufficient medical education, fears of possible drug-related side effects, and common misconceptions about the inevitability of pain in elderly and HD patients. Caregivers working in HD should be aware of the possible consequences of inadequate pain assessment and management. Common pain syndromes in HD patients include musculoskeletal diseases and metabolic neuropathies, associated with typical intradialytic pain. Evaluating the etiology, nature, and intensity of pain is crucial for choosing the correct analgesic. A mechanism-based approach to pain management may result in a better outcome. Pharmacokinetic considerations on clearance alterations and possible toxicity in patients with ESRD should drive the right analgesic prescription. Comorbidities and polymedications may increase the risk of drug-drug interactions, therefore drug metabolism should be taken into account when selecting analgesic drugs. Automedication is common among HD patients but should be avoided to reduce the risk of hazardous drug administration. Further research is warranted to define the efficacy and safety of analgesic drugs and techniques in the context of patients with ESRD as generalizing information from studies conducted in the general population could be inappropriate and potentially dangerous. A multidisciplinary approach is recommended for the management of complex pain syndromes in frail patients, such as those suffering from ESRD.
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Affiliation(s)
- Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
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Vapocoolant spray versus placebo spray/no treatment for reducing pain from intravenous cannulation: A meta-analysis of randomized controlled trials. Am J Emerg Med 2018; 36:2085-2092. [DOI: 10.1016/j.ajem.2018.03.068] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 03/24/2018] [Accepted: 03/24/2018] [Indexed: 12/25/2022] Open
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Matsumoto T, Chaki T, Hirata N, Yamakage M. The eutectic mixture local anesthetics (EMLA) cream is more effective on venipuncture pain compared with lidocaine tape in the same patients. JA Clin Rep 2018; 4:73. [PMID: 32026028 PMCID: PMC6966927 DOI: 10.1186/s40981-018-0210-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction Although venous cannulation is imperative during perioperative period, it inevitably causes venipuncture pain. Eutectic mixture local anesthetics (EMLA) has been used to reduce this pain, and various studies have been conducted to evaluate the efficacy of EMLA. But these studies did not elucidate the effect of EMLA exactly, because there were large individual differences in pain sensitivity. The aim of this study is to accurately evaluate the efficacy of EMLA cream for venipuncture pain relief compared with lidocaine tape in the same patients. Methods Participants were randomly allocated into EL or LE group. Participants received EMLA cream at one side dorsum of hand and lidocaine tape at another dorsum of hand before entering operation room. Local anesthetics were strictly applied according to their manufacturers’ instruments, respectively. In the EL group, participants received venipuncture at EMLA cream site firstly. In LE group, participants, conversely, received venipuncture at lidocaine tape site firstly. Before anesthetic induction, local anesthetics were removed followed by venous cannulations. After cannulation, participants evaluated the pain by visual analog scale (VAS) and verbal rating scale (VRS).The primary outcome was VAS, and the secondary outcome was VRS. Results Data from 24 patients were analyzed. The VAS of EMLA cream was significantly lower than that of lidocaine tape (4 [0–18] vs 17 [8–45], p = 0.001, 95% CI − 25 to − 6). The VRS of EMLA cream was also significantly lower than that of lidocaine tape (2 [1–2] vs 2 [2–3], p = 0.002, 95% CI − 0.8 to − 0.2). The local skin adverse events were observed in five patients at EMLA cream applied hands. Conclusions We conducted a comparative study to elucidate the efficacy of EMLA cream for venipuncture-pain comparing with lidocaine tape in the same patients. Our results strongly suggest that EMLA cream is more effective for venipuncture pain relief than lidocaine tape. Trial registrations UMIN Clinical Trials Registry, UMIN000023030. Registered 5 July 2016.
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Affiliation(s)
- Tomomi Matsumoto
- Department of Anesthesiology, Tomakomai City Hospital, 1-5-20, Shimizu-cho, Tomakomai, Hokkaido, Japan
| | - Tomohiro Chaki
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan.
| | - Naoyuki Hirata
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Michiaki Yamakage
- Department of Anesthesiology, Sapporo Medical University School of Medicine, 291, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
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Comparison between Vapocoolant Spray and Eutectic Mixture of Local Anesthetics Cream in Reducing Pain during Spinal Injections. Anesthesiol Res Pract 2018; 2018:5050273. [PMID: 30271434 PMCID: PMC6151195 DOI: 10.1155/2018/5050273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/11/2018] [Accepted: 08/03/2018] [Indexed: 11/17/2022] Open
Abstract
Background Eutectic mixture of local anesthetics (EMLA) cream is often used for local anesthesia during spinal injections. However, this agent has delayed onset of action while vapocoolant spray serves more advantages. The vapocoolant spray containing ethyl chloride has fast onset and is safe, low cost, and widely available. This study aimed at comparing the effectiveness of vapocoolant spray and EMLA cream in reducing pain for spinal injections. Methods This was an experimental study on 94 subjects with 47 subjects treated with EMLA cream and 47 subjects treated with vapocoolant spray. The effectiveness of anesthesia was assessed by using Numeric Pain Rating Scale (NPRS) and patient movement during the surgery. Results This study found that the pain scale was NPRS 0 (0–3) for the EMLA group and NPRS 0 (0–4) for the vapocoolant spray group. There was no significant difference between two groups for pain scale according to the Mann–Whitney U test. For patient movement, the movement was reported only in one (2.1%) patient in the EMLA group and one (2.1%) patient in the vapocoolant spray group. Based on Fisher's test, there was no significant difference between the two groups for patient movement. Conclusions Both EMLA cream and vapocoolant spray were equally effective in reducing pain during spinal injection. There was no difference in degree of pain reduction and patient movement between the EMLA cream group and the vapocoolant spray group during spinal injection.
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Zeiderman M, Kelishadi S, Tutela J, Rao A, Chowdhry S, Brooks R, Wilhelmi B. Vapocoolant Anesthesia for Cosmetic Facial Rejuvenation Injections: A Randomized, Prospective, Split-Face Trial. EPLASTY 2018; 18:e6. [PMID: 29484087 PMCID: PMC5809626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Minimally invasive cosmetic procedures are the most commonly performed aesthetic techniques by plastic surgeons. Patients are interested in a pain-free experience. Surgeons desire patient satisfaction and time-efficient utilization of office staff and resources. Clinical evidence exists for use of vapocoolant technology to reduce pain associated with intravenous cannulation in the pediatric population and in hemodialysis patients. Applying vapocoolant technology to facial rejuvenation is a novel approach to decrease pain associated with neurotoxin or filler injection. Methods: A randomized, prospective study was conducted, testing 15 subjects receiving filler injections and another 15 patients receiving neurotoxin injections using a split-face model. The vapocoolant spray used was composed of a 95:5 ratio of 1,1,1,3,3-pentafluoropropane and 1,1,1,2-tetrafluoroethane. Within each group, individual patients randomly received injection (filler or neurotoxin) alone versus injection (filler or neurotoxin) plus vapocoolant on an equivalent half of his or her face. An independent examiner recorded from each patient on a scale of 1 to 10 perceived pain for injection alone versus injection plus vapocoolant spray. Results were calculated as a percentage change of pain scores experienced after injection for each person between the control (nonvapocoolant) and treatment (vapocoolant) sides of the face. Results: Vapocoolant spray at the time of cosmetic facial injections leads to a 59% decrease in perceived pain score with neurotoxin injections (range, 0%-100% change) and 64% decrease in perceived pain score with filler injections (range, 0%-100% change). These results were statistically significant with P < .05. Conclusion: Vapocoolant spray reduces pain associated with facial rejuvenation procedures.
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Affiliation(s)
- Matthew R. Zeiderman
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Shahrooz Sean Kelishadi
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky
- SSK Plastic and Reconstructive Surgery, Newport Beach, Calif
| | - John Paul Tutela
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Arun Rao
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Saeed Chowdhry
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Ronald M. Brooks
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky
| | - Bradon J. Wilhelmi
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky
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Shabandokht-Zarmi H, Bagheri-Nesami M, Shorofi SA, Mousavinasab SN. The effect of self-selected soothing music on fistula puncture-related pain in hemodialysis patients. Complement Ther Clin Pract 2017; 29:53-57. [PMID: 29122269 DOI: 10.1016/j.ctcp.2017.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 08/17/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This study was intended to examine the effect of selective soothing music on fistula puncture-related pain in hemodialysis patients. MATERIALS AND METHODS This is a randomized clinical trial in which 114 participants were selected from two hemodialysis units by means of a non-random, convenience sampling method. The participants were then allocated in three groups of music (N = 38), headphone (N = 38), and control (N = 38). The fistula puncture-related pain was measured 1 min after venipuncture procedure in all three groups. The music group listened to their self-selected and preferred music 6 min before needle insertion into a fistula until the end of procedure. The headphone group wore a headphone alone without listening to music 6 min before needle insertion into a fistula until the end of procedure. The control group did not receive any intervention from the research team during needle insertion into a fistula. The pain intensity was measured immediately after the intervention in all three groups. RESULTS This study showed a significant difference between the music and control groups, and the music and headphone groups in terms of the mean pain score after the intervention. However, the analysis did not indicate any significant difference between the headphone and control groups with regard to the mean pain score after the intervention. CONCLUSION It is concluded that music can be used effectively for pain related to needle insertion into a fistula in hemodialysis patients. Future research should investigate the comparative effects of pharmacological and non-pharmacological interventions on fistula puncture-related pain.
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Affiliation(s)
- Hosniyeh Shabandokht-Zarmi
- Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Bagheri-Nesami
- Traditional and Complementary Medicine Research Centre, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Seyed Afshin Shorofi
- Traditional and Complementary Medicine Research Centre, Mazandaran University of Medical Sciences, Sari, Iran; Flinders University, Adelaide, Australia
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Comparing the effectiveness of vapocoolant spray and lidocaine/procaine cream in reducing pain of intravenous cannulation: A randomized clinical trial. Am J Emerg Med 2017; 35:1064-1068. [DOI: 10.1016/j.ajem.2017.02.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/25/2017] [Indexed: 11/23/2022] Open
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Mirzaei S, Javadi M, Eftekhari A, Hatami M, Hemayati R. Efficacy of application of eutectic mixture of local anesthetics and lidocaine spray in pain management of arteriovenous fistula cannulation in hemodialysis patients. J Renal Inj Prev 2017. [DOI: 10.15171/jrip.2017.51] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Mace SE. Prospective, double blind, randomized, controlled trial comparing vapocoolant spray versus placebo spray in adults undergoing intravenous cannulation. Scand J Pain 2017; 17:8-15. [PMID: 28850378 DOI: 10.1016/j.sjpain.2017.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 06/07/2017] [Accepted: 06/10/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Painful diagnostic and therapeutic procedures are common in the health care setting. Eliminating, or at least, minimizing the pain associated with various procedures should be a priority. Although there are many benefits of providing local/topical anesthesia prior to performing painful procedures, ranging from greater patient/family satisfaction to increased procedural success rates; local/topical anesthetics are frequently not used. Reasons include the need for a needlestick to administer local anesthetics such as lidocaine and the long onset for topical anesthetics. Vapocoolants eliminate the risks associated with needlesticks, avoids the tissue distortion with intradermal local anesthetics, eliminates needlestick pain, have a quick almost instantaneous onset, are easy to apply, require no skills or devices to apply, are convenient, and inexpensive. The aims of this study were to ascertain if peripheral intravenous (PIV) cannulation pain would be significantly decreased by using a vapocoolant (V) versus sterile water placebo (S) spray, as determined by a reduction of at least ≥1.8 points on numerical rating scale (NRS) after vapocoolant versus placebo spray, the side effects and incidence of side effects from a vapocoolant spray; and whether there were any long term visible skin abnormalities associated with the use of a vapocoolant spray. MATERIALS AND METHODS Prospective, randomized, double-blind controlled trial of 300 adults (ages 18-80) requiring PIV placement in a hospital ED, randomized to S (N=150) or V (N=150) prior to PIV. Efficacy outcome was the difference in PIV pain: NRS from 0 (none) to worst (10). Safety outcomes included a skin checklist for local adverse effects (i.e., redness, blanching, edema, ecchymosis, itching, changes in skin pigmentation), vital sign (VS) changes, and before/after photographs of the PIV site. RESULTS Patient demographics (age, gender, race), comorbidity, medications, and vital signs; and PIV procedure variables (e.g., IV needle size, location, number of IV attempts, type and experience of healthcare provider performing the IV) were not significantly different for the two groups. Median (interquartile range) PIV pain was 4 (2, 7) (S) and 2 (0, 4) (V) (P<0.001). Skin checklist revealed minimal erythema: S 0% (N=0/150), V: 2.7% (4/150), which resolved within 5min, and no blanching, skin pigmentation changes, itching, edema, or ecchymosis. Photographs at 5-10min revealed no visible skin changes in any patient (N=300), vapocoolant (N=150) or placebo groups (N=150). Complaints (N=26) were coolness/cold feeling S 8.7% (N=13), V 7.3% (N=11), coolness/numbness S 0% (N=0), V 0.7% (N=1), and burning S 0.7% (N=1), V 0 (0%). Patient acceptance of the vapocoolant spray was high: 82% (123/150) of the patients stated they would use the spray in the future, while only 40.7% (61/150) of the placebo group stated they would use the placebo spray in the future. CONCLUSIONS AND IMPLICATIONS Vapocoolant spray significantly decreased peripheral intravenous cannulation pain in adults versus placebo spray and was well tolerated with minor adverse effects that resolved quickly. There were no significant differences in vital signs and no visible skin changes documented by photographs taken within 5-10min postspray/PIV.
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Affiliation(s)
- Sharon E Mace
- Professor of Medicine, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Faculty MetroHealth Medical Center/Cleveland Clinic Emergency Medicine Residency, Cleveland, OH, United States; Director of Research Cleveland Clinic Emergency Services Institute, Cleveland Clinic, 9500 Euclid Ave, E-19, Cleveland, OH 44195, United States.
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