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Shi S, Zhu R, Huang X, Qu Y, Liang Q, Lin Q, Chen Y, Li Q, Liao T, Xin M. Comparison of the effects of Valsalva maneuver, EMLA cream, and the combination of both in relieving pain of needle insertion on totally implantable access port: A randomized controlled study. J Vasc Access 2024; 25:1576-1583. [PMID: 37334780 DOI: 10.1177/11297298231169155] [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] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Totally implantable access port (TIAP) is a subcutaneously implanted, long-term infusion device that is widely used in oncology patients. However, multiple needle insertions into TIAP may lead to pain, anxiety, and dread in patients. This study aimed to compare the effectiveness of Valsalva maneuver, eutectic mixture of local anesthetics (EMLA) cream, and the combination of both in relieving pain of cannulations on TIAP. METHODS This was a prospective randomized controlled study. We included 223 patients treated with antineoplastic drugs and randomized them into four groups: EMLA Group (Group E), control Group (Group C), Valsalva maneuver Group (Group V), and EMLA cream combing with Valsalva maneuver Group (Group EV). Each group was given the corresponding intervention before non-coring needle insertion. The data on pain scores and overall comfort were collected by numerical pain rating scale (NPRS) and visual analog scale (VAS). RESULTS Group E and Group EV experienced the least amount of pain scores in needle insertion, which was significantly lower than Group V and Group C (p < 0.05). Meanwhile, Group E and Group EV obtained the highest comfort level, which was significantly higher than group C (p < 0.05). Fifteen patients developed localized skin erythema after the application of medical Vaseline or EMLA cream and subsided within half an hour after rubbing. CONCLUSION EMLA cream is a safe and effective way to alleviate pain during non-coring needle insertion in TIAP and enhance the overall comfort of patients. We recommend applying EMLA cream 1 h before needle insertion of TIAP, especially in patients having needle phobia or high pain scores from previous non-coring needle insertion.
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Affiliation(s)
- Simei Shi
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Ruiyun Zhu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Xuxia Huang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Yanshan Qu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Qingtao Liang
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Qiulian Lin
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Youjing Chen
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Qiao Li
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Ting Liao
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
| | - Mingzhu Xin
- Department of Nursing, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China
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Hosseini SJ, Manzari ZS, Karkhah S, Heydari A. The effects of Valsalva maneuver on pain intensity and hemodynamic status during short peripheral cannula insertion in adults: A systematic review and meta-analysis. J Vasc Access 2024; 25:1051-1062. [PMID: 36573708 DOI: 10.1177/11297298221145982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
This systematic review and meta-analysis aimed to summarize the randomized clinical trial studies regarding the effects of Valsalva maneuver on the severity of short peripheral cannula insertion pain and hemodynamic status in adults. A systematic search was conducted on PubMed, Web of Science, Scopus databases, Cochrane, ClinicalTrials.gov, and Google Scholar Search Engine using keywords extracted from Medical Subject Headings, such as "Valsalva Maneuver," "Valsalva's Maneuver," "Forced Expiratory," "Balloon Inflation," "Pain," "Ache," "Cannulation," "Peripheral Intravenous Cannulation," "Peripheral Catheterization," "Vascular Access," "Venous Cannulation," "Venous Catheterization," and "Catheterization," from the inception to January 1, 2022. Finally, 12 and 11 articles were included in the qualitative and quantitative analysis of this systematic review and meta-analysis, respectively. Overall, pain intensity based on both the Numeric Rating Scale and Visual Analog Scale resulted in a large clinical effect (Effect Size: -1.20, 95% Confidence Interval: -1.69 to -0.71, p < 0.001). A large clinical effect was observed in a separate study of both scales because clinical effect has been determined in studies based on the Numeric Rating Scale (Effect Size: -1.26, 95% Confidence Interval: -1.90 to -0.62, p < 0.001 (and Visual Analog Scale (Effect Size: -1.09, 95% Confidence Interval: -1.98 to -0.20, p = 0.016). Valsalva maneuver significantly increased the mean heart rate (Weighted Mean Difference: 1.90, 95% Confidence Interval: 1.56-2.24, p < 0.001), decreased the mean arterial pressure (Weighted Mean Difference: 0.73, 95% Confidence Interval: -0.13 to 1.60, p = 0.096), and caused a non-significant decrease in anxiety (Weighted Mean Difference: -1.95, 95% Confidence Interval: -5.24 to 1.34, p = 0.25). The results showed that Valsalva maneuver significantly reduced pain intensity. Therefore, it is recommended that nurses use it as a convenient and low-cost non-pharmacological intervention to alleviate the severity of pain in non-cardiac patients. Also, it is suggested to conduct the studies with a strong methodological design and consider its effects on hemodynamic parameters in future investigations.
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Affiliation(s)
- Seyed Javad Hosseini
- Department of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra-Sadat Manzari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
- Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Shi H, Li X, Huang X, Yang H, Li J, Yang X. Efficacy and safety of the Valsalva maneuver in relieving venipuncture pain in children and adults: A systematic review and meta-analysis. J Vasc Access 2024:11297298241231903. [PMID: 38390709 DOI: 10.1177/11297298241231903] [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: 02/24/2024] Open
Abstract
Venipuncture is a common invasive clinical procedure, and pain management during puncture has been of interest to healthcare professionals. The purpose of this systematic review and meta-analysis was to evaluate the efficacy and safety of the Valsalva maneuver (VM) for the relief of venipuncture pain in children and adults. PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP database, and CBM were searched from inception to December 2023 for all available randomized controlled trials (RCTs) that evaluated the impact of VM on venipuncture. Two reviewers independently performed study selection, data extraction, and risk of bias assessment. Continuous variables were analyzed by mean differences (MD) or standardized mean differences (SMD), whereas dichotomous variables were analyzed by risk ratios (RR). A total of 22 studies involving 1740 participants were included. The pooled results showed that VM relieved pain intensity during venipuncture in children (SMD = -0.89, 95% CI = -1.47 to -0.30, p = 0.003) and adults (SMD = -1.11, 95% CI = -1.46 to -0.77, p < 0.00001), reduced anxiety intensity (SMD = -1.07, 95% CI = -1.68 to -0.47, p = 0.0005), and shortened puncture time (MD = -13.52, 95% CI = -21.14 to -5.90, p = 0.0005). There was no significant difference in the success rate of venous cannulation, MAP, HR, or incidence of adverse events in subjects who performed VM compared to controls. VM was an effective and safe method of pain management that reduced pain intensity during venipuncture in children and adults without significant adverse effects. The results of this meta-analysis need to be further validated by more rigorous and larger RCTs.
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Affiliation(s)
- Haoning Shi
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Xia Li
- Department of Ophthalmology, Affiliated Hospital of Weifang Medical University, Weifang, Shandong Province, PR China
| | - Xiaotong Huang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Haoran Yang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Jing Li
- School of Public Health, Weifang Medical University, Weifang, Shandong Province, PR China
| | - Xiao Yang
- School of Nursing, Weifang Medical University, Weifang, Shandong Province, PR China
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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: 2] [Impact Index Per Article: 1.0] [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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5
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Ghods AA, Roshani A, Mirmohammadkhani M, Soleimani M. Effects of Valsalva Maneuver on Pain and Vasovagal Reaction During the Removing of Femoral Arterial Sheath After Percutaneous Coronary Intervention: A Randomized Controlled Trial. J Perianesth Nurs 2022; 37:900-906. [PMID: 35618614 DOI: 10.1016/j.jopan.2022.01.016] [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: 11/02/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The objective of this study was to investigate the effects of the Valsalva maneuver on pain and vasovagal reactions during femoral arterial sheath removal in patients undergoing percutaneous coronary intervention. DESIGN This study was a randomized controlled trial. METHODS In this study, 60 patients undergoing elective coronary angioplasty were randomly assigned to the intervention and control groups. After angioplasty, the patients in the intervention group performed the Valsalva maneuver (20-30 mm Hg) for 10 seconds during the sheath removal. Conversely, in the control group, no inspiratory pressure was applied. Before and immediately after the sheath removal, the patients' pain, vital signs, and vasovagal reactions were measured. FINDINGS The primary characteristics of the patients were similar in the two groups. The patients in the intervention group had significantly lower pain scores during femoral sheath removal compared to the control group (2.33 ± 1.56 vs 5.56 ± 3.08, P < .001). The Valsalva maneuver during femoral sheath removal decreased the patients' heart rate in the intervention group compared to the control group (78.26 ± 12.37 vs 85.46 ± 11.79, P < .001); however, blood pressure and vasovagal reactions were not significantly different. CONCLUSIONS This study showed that the Valsalva maneuver during femoral arterial sheath removal can reduce the pain severity score, without increasing the incidence of vasovagal reactions.
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Affiliation(s)
- Ali Asghar Ghods
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Akram Roshani
- Faculty of Nursing and Midwifery, Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Majid Mirmohammadkhani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohsen Soleimani
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan, Iran.
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Alan N, Khorshid L. Evaluation of Efficacy of Valsalva Maneuver During Peripheral Intravenous Cannulation on Pain. Pain Manag Nurs 2021; 23:220-224. [PMID: 33712356 DOI: 10.1016/j.pmn.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AIMS: The aim of this study was to examine the effects of the Valsalva maneuver during peripheral intravenous catheter (PIVC) insertion on procedure-related pain. DESIGN This work was a prospective randomized controlled study. SETTINGS Study was conducted in the orthopedics clinic of a university hospital. PARTICIPANTS/SUBJECTS METHODS: The sample of patients (N = 110) was allocated to the Valsalva maneuver group (n = 55) and control group (n = 55) by using blocked randomization to reduce bias and achieve balance according to age and gender. Pain was evaluated by using Numerical Rating Scale. Systolic/diastolic blood pressure and heart rate before and after the PIVC placement was recorded. RESULTS The patients in the intervention group had less severe pain during the PIVC insertion than the patients in the control group (p ˂ .001). After PIVC placement, systolic blood pressure was significantly reduced in both groups (p = .008), no other variables changed significantly. No clinical complication related to the Valsalva maneuver occurred in the intervention group. CONCLUSION Valsalva maneuver can be used as a non-pharmacologic method to reduce pain during PIVC placement.
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Affiliation(s)
- Nurten Alan
- Dokuz Eylül University Nursing Faculty, İzmir, Turkey.
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Simón-López LC, Luquero-Bueno S, Ovejero-Benito MC, Cuesta-Lozano D, Goodman-Casanova JM, Vargas-Castrillón E, Mazarro DO, De Miguel-Cáceres A, Posada-Moreno P, Zaragoza-García I, Ortuño-Soriano I. Benefits of the application of heat and pressure on peripheral venous cannulation in adults: A randomized controlled trial. J Adv Nurs 2020; 77:1533-1545. [PMID: 33219590 DOI: 10.1111/jan.14655] [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: 04/10/2020] [Revised: 09/24/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effectiveness of the application of topical heat, high pressure or a combination of both on antebrachial venous cannulation. DESIGN A cross-over clinical trial blinded for haemolysis analysis. METHODS This cross-over clinical trial with two periods was performed in the Clinical Trial Unit of Hospital Universitario de La Princesa (Madrid) during June-July of 2017 in 59 healthy adults who were randomly allocated to one of three interventions: (1) Using dry topical heat for 7 min produced by two hot seed bags (N = 21), (2) Applying controlled pressure from a sphygmomanometer inflated to 100 mmHg (N = 18) and (3) combining heat and pressure (N = 20) in one period out of two. All interventions were contrasted to standard clinical practice in the other period. The comparator involved a standard tourniquet around the upper arm to restrict venous blood flow. The primary outcome was effectiveness measured as vein cannulation at first attempt. Secondary outcomes were vein perception, pain, haemolysis in blood samples and adverse events. RESULTS All the interventions were more effective than comparator. Vein perception was optimized in about all individuals. Moreover, pain relief was significantly higher when high pressure was applied. Haemolysis was not affected in any of the three interventions. In addition, no serious adverse events appeared. CONCLUSION High pressure is determined to be the most effective in vein catheterization, pain relief, vein perception and quality of blood sample inalterability. Moreover, it is safe considering that only one adverse event appeared. IMPACT Vein cannulation is a very common invasive technique, where repeated failures have been registered. Thus, we consider it relevant to develop interventions to achieve venous catheterization at first attempt to alleviate the pain and anxiety associated with this technique. We advocate using high pressure intervention for emergency, due to swiftest method and feasible in case of lacking resources, such as sphygmomanometers in the ambulance. Interventions can be extrapolated to healthy young adults, adults and patients who have healthy vein status perception. Pressure intervention could be an alternative to heat intervention when performing vein cannulation due to its lower risk of transient paresthesia for older people who often suffer from arterial hypertension.
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Affiliation(s)
- Leticia Carmen Simón-López
- Nursing and Physiotherapy Department, Universidad de Alcalá (UAH), Madrid, Spain.,Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain.,Nursing Department, Universidad Complutense de Madrid, Madrid, Spain
| | - Sergio Luquero-Bueno
- Biobank Department, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - María C Ovejero-Benito
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - Daniel Cuesta-Lozano
- Nursing and Physiotherapy Department, Universidad de Alcalá (UAH), Madrid, Spain
| | | | - Emilio Vargas-Castrillón
- Clinical Pharmacology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Dolores Ochoa Mazarro
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - Alejandro De Miguel-Cáceres
- Clinical Pharmacology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria la Princesa (IIS-IP), Madrid, Spain
| | - Paloma Posada-Moreno
- Nursing Department, Universidad Complutense de Madrid, Madrid, Spain.,Development, Research and Innovation Area, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ignacio Zaragoza-García
- Nursing Department, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital 12 de Octubre (I+12), Madrid, Spain
| | - Ismael Ortuño-Soriano
- Nursing Department, Universidad Complutense de Madrid, Madrid, Spain.,Development, Research and Innovation Area, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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8
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Basak T, Duman S, Demirtas A. Distraction‐based relief of pain associated with peripheral intravenous catheterisation in adults: a randomised controlled trial. J Clin Nurs 2019; 29:770-777. [DOI: 10.1111/jocn.15131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/06/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Tulay Basak
- Gulhane Faculty of Nursing Fundamentals of Nursing Department University of Health Sciences Ankara Turkey
| | - Senem Duman
- Gulhane Faculty of Nursing Fundamentals of Nursing Department University of Health Sciences Ankara Turkey
| | - Ayla Demirtas
- Gulhane Faculty of Nursing Fundamentals of Nursing Department University of Health Sciences Ankara Turkey
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Mechanisms of "Cough-Trick" for Pain Relief during Venipuncture: An Experimental Crossover Investigation in Healthy Volunteers. Pain Res Manag 2019; 2019:9459103. [PMID: 31915500 PMCID: PMC6930711 DOI: 10.1155/2019/9459103] [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: 09/06/2019] [Revised: 11/09/2019] [Accepted: 11/26/2019] [Indexed: 12/04/2022]
Abstract
Objectives The easily performed “cough-trick” (CT) reduces pain during venipuncture (VP), although the underlying mechanism remains unclear. The aim was to investigate the pain-reducing effect of CT during VP in comparison with two distraction methods, as well as under the influence of naloxone. Methods 54 healthy male volunteers participated in 3 investigations. Pain during standardized VP with CT was compared to a “weak” distraction (squeezing a rubber ball; investigation 1; n=20) and to a “strong” distraction (inflating a tourniquet to a given pressure; investigation 2; n=21). In investigation 3 (n=13), pain at a VP without intervention was compared to pain at VP with CT under naloxone; pressure pain thresholds before and after naloxone administration were also measured. Pain was assessed using a 100 mm visual analogue scale. Data were compared within each sample using Student's t-test for paired samples. Results Pain intensity at VP with CT was lower than under “weak” distraction (mean difference 5 mm; 95% CI: 0.5 to 9.6; P=0.03). Pain levels under CT and “strong” distraction were comparable. There was no difference between pain under CT after naloxone infusion and pain without intervention. Pressure pain threshold decreased (mean difference 1 mm; 95% CI: 0.1 to 1.0 mm; P=0.02) after naloxone administration. Conclusion Pain-reducing effect of CT during VP is superior to that of simple motor distraction and equivalent to a complex distraction method. This might be due to the activation of segmental pain inhibitory pathways during coughing indicated through the lack of pain reduction due to CT under opioid antagonist blockage.
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10
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Yılmaz D, Güneş ÜY. The effect on pain of three different nonpharmacological methods in peripheral intravenous catheterisation in adults. J Clin Nurs 2017; 27:1073-1080. [PMID: 29076581 DOI: 10.1111/jocn.14133] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To compare the effectiveness in reducing pain during peripheral intravenous catheterisation of coughing, blowing into a spirometer and squeezing a stress ball. BACKGROUND Peripheral intravenous catheterisation is widely performed by nurses; it causes pain and discomfort to patients. DESIGN This was a single-blind randomized controlled study. METHODS The sample of the study consisted of 120 males who came to donate blood. Before the peripheral intravenous catheterisation, the individuals were divided by a simple randomisation method into four groups: a coughing group, a blowing into a spirometer group, a stress ball squeezing group and a control group. During the procedure, the pain levels felt by the individuals were assessed using the visual analog scale by a nurse who was blinded to the procedure. FINDINGS The mean pain of the individuals in the coughing group was found to be 19.5 mm (SD: 13.6), that of the spirometer group was 28.3 mm (SD: 20.2), that of the stress ball group was 32.1 mm (SD: 23.8) and that of the control group was 45.5 mm (SD: 19.5). Statistical analysis showed a significant difference between the mean pain scores of individuals in the control group and those of individuals in the coughing, spirometer and stress ball groups. CONCLUSION The techniques of squeezing a stress ball, blowing into a spirometer and in particular coughing, depending on the potential mechanism of the Valsalva manoeuvre and diverting attention, are effective techniques in reducing the pain of peripheral catheterisation procedures. RELEVANCE TO CLINICAL PRACTICE It is important that nurses should be aware of pain and stress experienced by patients during invasive procedures. For this reason, nurses should have knowledge of proven nonpharmacological methods which can reduce pain to a minimum.
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Affiliation(s)
- Dilek Yılmaz
- Department of Nursing, Uludag University Faculty of Health Sciences, Bursa, Turkey
| | - Ülkü Yapucu Güneş
- Department of Fundamentals of Nursing, Ege University Faculty of Nursing, İzmir, Turkey
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11
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Ricci S, Moro L, Minotti GC, Incalzi RA, De Maeseneer M. Valsalva maneuver in phlebologic practice. Phlebology 2017; 33:75-83. [PMID: 28081660 DOI: 10.1177/0268355516678513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Forced expiration against an airway obstruction was originally described as a method for inflating the Eustachian tubes and is accredited to Antonio Maria Valsalva (1666-1723). The Valsalva maneuver is commonly applied for different diagnostic purposes. Its use for phlebologic diagnosis is the object this review. Venous reflux is the most frequent pathophysiologic mechanism in chronic venous disease. Reflux is easily visualized by duplex ultrasound when properly elicited, in standing position. A simple way to elicit reflux is the so-called "compression-release maneuver": by emptying the muscle reservoir, it determines a centrifugal gradient, dependent on hydrostatic pressure, creating an aspiration system from the superficial to the deep system. The same results are obtained with dynamics tests activating calf muscles. The Valsalva maneuver elicits reflux by a different mechanism, increasing the downstream pressure and, thus, highlighting any connection between the source of reflux and the refluxing vessel. The Valsalva maneuver is typically used to investigate the saphenofemoral junction. When the maneuver is performed correctly, it is very useful to analyse several conditions and different hemodynamic behaviours of the valvular system at the saphenofemoral junction. Negative Valsalva maneuver always indicates valvular competence at the saphenofemoral junction. Reverse flow lasting during the whole strain (positive Valsalva maneuver) indicates incompetence or absence of proximal valves. Coupling Valsalva maneuver to compression-release maneuver, with the sample volume in different saphenofemoral junction sections, may reveal different hemodynamic situations at the saphenofemoral junction, which can be analysed in detail.
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Affiliation(s)
- Stefano Ricci
- 1 Centro di Flebologia, Area di Geriatria, Università Campus Bio Medico, Roma, Italy
| | - Leo Moro
- 1 Centro di Flebologia, Area di Geriatria, Università Campus Bio Medico, Roma, Italy
| | | | - Raffaele A Incalzi
- 1 Centro di Flebologia, Area di Geriatria, Università Campus Bio Medico, Roma, Italy
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Srivastava VK, Das PK, Gautam SK, Jaisawal P, Kadiyala VN, Rambhad S. Comparative Evaluation of Volatile Anaesthetic Agents for Attenuation of Venous Cannulation Pain: A Prospective, Randomized Controlled Study. J Clin Diagn Res 2016; 10:UC01-UC04. [PMID: 27790552 DOI: 10.7860/jcdr/2016/19970.8412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Topical application of volatile anaesthetic agents has been found to attenuate the response to a mechanical stimulus; however, this effect of volatile anaesthetic on perception of pain during venous cannulation is not known. AIM To compare the efficacy of topically administered volatile anaesthetic agents for attenuating venous cannulation pain. MATERIALS AND METHODS This prospective, randomized, placebo controlled and double blind study was conducted on 120 patients, aged 20-60years. They were of American Society of Anaesthesiologists (ASA) I or II physical status, of either sex, planned for elective surgeries. These patients were randomized into 4 groups, of 30 each. Equipotent doses of halothane (1ml), isoflurane (1.5ml), sevoflurane (2.7ml) and sterile water (2.5ml; Control) were topically administered on the volar surface of forearm wrapped with cotton and aluminium foil; venous cannulation was performed with 18G intravenous cannula after 30 min. These patients were assessed for the incidence and severity of pain upon venous cannulation {visual analog scale (VAS), 0-100mm; 0 = no pain and 100 = worst imaginable pain}. Data were analysed by one-way ANOVA, Chi-square test and Kruskal-Wallis test. The p<0.05 was considered as significant. RESULTS A significant reduction in the incidence of venous cannulation pain was observed in the halothane (79%) group as compared to control (100%; p<0.05), isoflurane (100%; p<0.05) and sevoflurane (100%; p<0.05) groups. The severity of venous cannulation pain as assessed by median (interquartile range, Q1-Q3). VAS scores was reduced in the halothane {10 (10-20); p<0.001}, isoflurane {20 (10-30); p<0.001} and sevoflurane {20 (20-30); p<0.001} groups as compared to the control group {40 (30-40)}; VAS score in the halothane group was significantly less as compared to isoflurane (p<0.05) and sevoflurane (p<0.05) groups. CONCLUSION Topical application of halothane is most effective in reducing incidence and severity of venous cannulation pain; however, topical application of isoflurane and sevoflurane decreases only the severity of venous cannulation pain.
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Affiliation(s)
- Vinit K Srivastava
- Senior Consultant, Department of Anaesthesiology, Apollo Hospitals , Bilaspur, Chhattisgarh, India
| | - Pravin K Das
- Associate Professor, Department of Anaesthesiology, Dr RML Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Sujeet Ks Gautam
- Assistant Professor, Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences , Lucknow, Uttar Pradesh, India
| | - Parineeta Jaisawal
- Consultant, Department of Anaesthesiology, Apollo Hospitals , Bilaspur, Chhattisgarh, India
| | - Venkat N Kadiyala
- DNB Student, Department of Anaesthesiology, Apollo Hospitals , Bilaspur, Chhattisgarh, India
| | - Sonal Rambhad
- DNB Student, Department of Anaesthesiology, Apollo Hospitals , Bilaspur, Chhattisgarh, India
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Tan PC, Mackeen A, Khong SY, Omar SZ, Azmi MAN. Peripheral Intravenous Catheterisation in Obstetric Patients in the Hand or Forearm Vein: A Randomised Trial. Sci Rep 2016; 6:23223. [PMID: 26987593 PMCID: PMC4796788 DOI: 10.1038/srep23223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/26/2016] [Indexed: 11/09/2022] Open
Abstract
A peripheral intravenous catheter is often inserted as part of care during labour. The catheter is inserted into the back of the hand or lower forearm vein in usual practice. There is no trial data to guide the care provider on which is the better insertion site in any clinical setting. 307 women admitted to the labour ward who required insertion of intravenous catheter were randomised to back of hand or lower forearm vein catheter insertion. Catheter insertion is by junior to mid-grade providers. We evaluated insertion success at the first attempt, pain during insertion and catheter replacement due to malfunction as main outcomes. After catheter removal, we recorded patient satisfaction with site, future site preference and insertion site swelling, bruising, tenderness, vein thrombosis and pain. Insertion of a catheter into back of hand vein is more likely to be successful at the first attempt. Insertion pain score, catheter replacement rate, patient satisfaction, patient fidelity to site in a future insertion and insertion site complications rate are not different between trial arms. In conclusion, both insertion sites are suitable; the back of the hand vein maybe easier to cannulate and seems to be preferred by our frontline providers.
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Affiliation(s)
- Peng Chiong Tan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Anjana Mackeen
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Su Yen Khong
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Siti Zawiah Omar
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - M. A. Noor Azmi
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur, Malaysia
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Boerner KE, Birnie KA, Chambers CT, Taddio A, McMurtry CM, Noel M, Shah V, Pillai Riddell R. Simple Psychological Interventions for Reducing Pain From Common Needle Procedures in Adults: Systematic Review of Randomized and Quasi-Randomized Controlled Trials. Clin J Pain 2015; 31:S90-8. [PMID: 26352921 PMCID: PMC4900414 DOI: 10.1097/ajp.0000000000000270] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND This systematic review evaluated the effectiveness of simple psychological interventions for managing pain and fear in adults undergoing vaccination or related common needle procedures (ie, venipuncture/venous cannulation). DESIGN/METHODS Databases were searched to identify relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear were prioritized as critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI). RESULTS No studies involving vaccination met inclusion criteria; evidence was drawn from 8 studies of other common needle procedures (eg, venous cannulation, venipuncture) in adults. Two trials evaluating the impact of neutral signaling of the impending procedure (eg, "ready?") as compared with signaling of impending pain (eg, "sharp scratch") demonstrated lower pain when signaled about the procedure (n=199): SMD=-0.97 (95% CI, -1.26, -0.68), after removal of 1 trial where self-reported pain was significantly lower than the other 2 included trials. Two trials evaluated music distraction (n=156) and demonstrated no difference in pain: SMD=0.10 (95% CI, -0.48, 0.27), or fear: SMD=-0.25 (95% CI, -0.61, 0.10). Two trials evaluated visual distraction and demonstrated no difference in pain (n=177): SMD=-0.57 (95% CI, -1.82, 0.68), or fear (n=81): SMD=-0.05 (95% CI, -0.50, 0.40). Two trials evaluating breathing interventions found less pain in intervention groups (n=138): SMD=-0.82 (95% CI, -1.21, -0.43). The quality of evidence across all trials was very low. CONCLUSIONS There are no published studies of simple psychological interventions for vaccination pain in adults. There is some evidence of a benefit from other needle procedures for breathing strategies and neutral signaling of the start of the procedure. There is no evidence for use of music or visual distraction.
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Affiliation(s)
- Katelynn E. Boerner
- Departments of Psychology and Neuroscience, IWK Health Centre
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | - Kathryn A. Birnie
- Departments of Psychology and Neuroscience, IWK Health Centre
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | - Christine T. Chambers
- Pediatrics and Psychology & Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy
- The Hospital for Sick Children
| | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Children’s Health Research Institute
- Department of Paediatrics, University of Western Ontario, London, ON
| | - Melanie Noel
- Department of Psychology, University of Calgary, AB, Canada
| | - Vibhuti Shah
- Health Policy Management and Evaluation, Faculty of Medicine, University of Toronto
- Mount Sinai Hospital, Toronto, ON
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Yuan H, Silberstein SD. Vagus Nerve and Vagus Nerve Stimulation, a Comprehensive Review: Part III. Headache 2015; 56:479-90. [PMID: 26364805 DOI: 10.1111/head.12649] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 12/23/2022]
Abstract
Vagus nerve stimulation (VNS) is currently undergoing multiple trials to explore its potential for various clinical disorders. To date, VNS has been approved for the treatment of refractory epilepsy and depression. It exerts antiepileptic or antiepileptogenic effect possibly through neuromodulation of certain monoamine pathways. Beyond epilepsy, VNS is also under investigation for the treatment of inflammation, asthma, and pain. VNS influences the production of inflammatory cytokines to dampen the inflammatory response. It triggers the systemic release of catecholamines that alleviates the asthma attack. VNS induces antinociception by modulating multiple pain-associated structures in the brain and spinal cord affecting peripheral/central nociception, opioid response, inflammation process, autonomic activity, and pain-related behavior. Progression in VNS clinical efficacy over time suggests an underlying disease-modifying neuromodulation, which is an emerging field in neurology. With multiple potential clinical applications, further development of VNS is encouraging.
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Affiliation(s)
- Hsiangkuo Yuan
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
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Cady RK, McAllister PJ, Spierings ELH, Messina J, Carothers J, Djupesland PG, Mahmoud RA. A randomized, double-blind, placebo-controlled study of breath powered nasal delivery of sumatriptan powder (AVP-825) in the treatment of acute migraine (The TARGET Study). Headache 2014; 55:88-100. [PMID: 25355310 PMCID: PMC4320758 DOI: 10.1111/head.12472] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the efficacy and safety of AVP-825, a drug–device combination of low-dose sumatriptan powder (22 mg loaded dose) delivered intranasally through a targeted Breath Powered device vs an identical device containing lactose powder (placebo device) in the treatment of migraine headache. Background Early treatment of migraine headaches is associated with improved outcome, but medication absorption after oral delivery may be delayed in migraineurs because of reduced gastric motility. Sumatriptan powder administered with an innovative, closed-palate, Bi-Directional, Breath Powered intranasal delivery mechanism is efficiently absorbed across the nasal mucosa and produces fast absorption into the circulation. Results from a previously conducted placebo-controlled study of AVP-825 showed a high degree of headache relief with an early onset of action (eg, 74% AVP-825 vs 38% placebo device at 1 hour, P < .01). Methods In this double-blind, placebo-controlled, parallel-group study in adults with a history of migraine with or without aura, participants were randomized via computer-generated lists to AVP-825 or placebo device to treat a single migraine headache of moderate or severe intensity. The primary endpoint was headache relief (defined as reduction of headache pain intensity from severe or moderate migraine headache to mild or none) at 2 hours post-dose. Results Two hundred and thirty patients (116 AVP-825 and 114 placebo device) were randomized, of whom 223 (112 and 111, respectively) experienced a qualifying migraine headache (their next migraine headache that reached moderate or severe intensity). A significantly greater proportion of AVP-825 patients reported headache relief at 2 hours post-dose compared with those using the placebo device (68% vs 45%, P = .002, odds ratio 2.53, 95% confidence interval [1.45, 4.42]). Between-group differences in headache relief were evident as early as 15 minutes, reached statistical significance at 30 minutes post-dose (42% vs 27%, P = .03), and were sustained at 24 hours (44% vs 24%, P = .002) and 48 hours (34% vs 20%, P = .01). Thirty-four percent of patients treated with AVP-825 were pain-free at 2 hours compared with 17% using the placebo device (P = .008). More AVP-825 patients reported meaningful pain relief (patient interpretation) of migraine within 2 hours of treatment vs placebo device (70% vs 45%, P < .001), and fewer required rescue medication (37% vs 52%, P = .02). Total migraine freedom (patients with no headache, nausea, phonophobia, photophobia, or vomiting) reached significance following treatment with AVP-825 at 1 hour (19% vs 9%; P = .04). There were no serious adverse events (AEs), and no systemic AEs occurred in more than one patient. Chest pain or pressure was not reported, and only one patient taking AVP-825 reported mild paresthesia. No other triptan sensations were reported. Conclusions Targeted delivery of a low-dose of sumatriptan powder via a novel, closed-palate, Breath Powered, intranasal device (AVP-825) provided fast relief of moderate or severe migraine headache in adults that reached statistical significance over placebo by 30 minutes. The treatment was well tolerated with a low incidence of systemic AEs.
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Djupesland PG, Messina JC, Mahmoud RA. Breath powered nasal delivery: a new route to rapid headache relief. Headache 2014; 53 Suppl 2:72-84. [PMID: 24024605 PMCID: PMC3786533 DOI: 10.1111/head.12186] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 12/02/2022]
Abstract
The nose offers an attractive noninvasive alternative for drug delivery. Nasal anatomy, with a large mucosal surface area and high vascularity, allows for rapid systemic absorption and other potential benefits. However, the complex nasal geometry, including the narrow anterior valve, poses a serious challenge to efficient drug delivery. This barrier, plus the inherent limitations of traditional nasal delivery mechanisms, has precluded achievement of the full potential of nasal delivery. Breath Powered bi-directional delivery, a simple but novel nasal delivery mechanism, overcomes these barriers. This innovative mechanism has now been applied to the delivery of sumatriptan. Multiple studies of drug deposition, including comparisons of traditional nasal sprays to Breath Powered delivery, demonstrate significantly improved deposition to superior and posterior intranasal target sites beyond the nasal valve. Pharmacokinetic studies in both healthy subjects and migraineurs suggest that improved deposition of sumatriptan translates into improved absorption and pharmacokinetics. Importantly, the absorption profile is shifted toward a more pronounced early peak, representing nasal absorption, with a reduced late peak, representing predominantly gastrointestinal (GI) absorption. The flattening and “spreading out” of the GI peak appears more pronounced in migraine sufferers than healthy volunteers, likely reflecting impaired GI absorption described in migraineurs. In replicated clinical trials, Breath Powered delivery of low-dose sumatriptan was well accepted and well tolerated by patients, and onset of pain relief was faster than generally reported in previous trials with noninjectable triptans. Interestingly, Breath Powered delivery also allows for the potential of headache-targeted medications to be better delivered to the trigeminal nerve and the sphenopalatine ganglion, potentially improving treatment of various types of headache. In brief, Breath Powered bi-directional intranasal delivery offers a new and more efficient mechanism for nasal drug delivery, providing an attractive option for improved treatment of headaches by enabling or enhancing the benefits of current and future headache therapies.
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