1
|
Han HS, Hong JY, Kwon TR, Lee SE, Yoo KH, Choi SY, Kim BJ. Mechanism and clinical applications of needle-free injectors in dermatology: Literature review. J Cosmet Dermatol 2021; 20:3793-3801. [PMID: 33682249 DOI: 10.1111/jocd.14047] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Needle-free jet injectors are devices that deliver drugs using a high-speed jet without a needle. Recent studies have significantly increased our understanding of the mechanisms of needle-free jet injectors, and technical advancements have broadened the scope of application of the device. AIMS We aimed to provide an up-to-date review of previous literature regarding the mechanism of action and clinical applications of needle-free jet injectors in dermatology field. METHODS We conducted a PUBMED search for studies on needle-free jet injectors using the following parameters: "Pneumatic injector" OR "needleless injector" OR "needle-free injector" OR "jet injector." Among 191 results, 72 articles focusing on their mechanisms of action, cutaneous delivery patterns, and clinical applications in dermatology were selected for review. RESULTS Significant clinical evidence has been published confirming the potential of needle-free jet injectors in treating various dermatologic conditions. In particular, these devices have the potential to be used in various skin remodeling treatment, especially in skin rejuvenation procedures by injecting various esthetic materials. CONCLUSION As proven by accumulated experience, the applications of NFJIs are not restricted to vaccine or insulin delivery in dermatology field. However, this literature review shows that until now, there are no clinical guidelines that standardize the optimal parameters when using NFJIs on various clinical settings. Therefore, further studies should be performed in order to investigate the full potential of these devices in dermatology, to ensure safe and effective outcomes in clinical practice.
Collapse
Affiliation(s)
- Hye Sung Han
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Ji Yeon Hong
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Tae Rin Kwon
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sung Eun Lee
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kwang Ho Yoo
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Sun Young Choi
- Department of Dermatology, Seoul Paik Hospital Inje University College of Medicine, Seoul, South Korea
| | - Beom Joon Kim
- Department of Dermatology, Chung-Ang University College of Medicine, Seoul, South Korea
| |
Collapse
|
2
|
Khoa LD, Quang TN, Toan PD, Loc NMT, Diem NTN, Dang VQ, Vu HNA, Mol BW, Handelsman DJ. Needle‐free jet versus conventional needle injection for local anesthesia in men undergoing surgical sperm retrieval. Andrology 2018; 7:69-75. [DOI: 10.1111/andr.12557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- L. D. Khoa
- IVFMD My Duc Hospital Ho Chi Minh Vietnam
| | - T. N. Quang
- Faculty of Public Health University of Medicine and Pharmacy Ho Chi Minh Vietnam
| | - P. D. Toan
- IVFMD My Duc Hospital Ho Chi Minh Vietnam
| | | | | | - V. Q. Dang
- IVFMD My Duc Hospital Ho Chi Minh Vietnam
| | | | - B. W. Mol
- Department of Obstetrics and Gynecology Monash University Melbourne Vic Australia
| | - D. J. Handelsman
- ANZAC Research Institute University of Sydney and Concord Repatriation General Hospital Concord NSW Australia
| |
Collapse
|
3
|
Hajiseyedjavady H, Saeedi M, Eslami V, Shahsavarinia K, Farahmand S. Less painful arterial blood gas sampling using jet injection of 2% lidocaine: a randomized controlled clinical trial. Am J Emerg Med 2012; 30:1100-4. [DOI: 10.1016/j.ajem.2011.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/20/2011] [Accepted: 07/21/2011] [Indexed: 11/16/2022] Open
|
4
|
Peng Y, Masson P, Li PS, Chang Y, Tian L, Lee R, Kim H, Sokal DC, Goldstein M. No-needle local anesthesia for adult male circumcision. J Urol 2010; 184:978-83. [PMID: 20643441 DOI: 10.1016/j.juro.2010.04.080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE We used a local anesthetic jet injection technique for adult male circumcision. This method eliminates needle use and may decrease the fear of local anesthetic injection used for male circumcision. MATERIALS AND METHODS We recruited 60 men seeking voluntary adult male circumcision into the study from June to September 2009. We used a MadaJet Medical Injector to deliver a high pressure spray of 0.1 ml 2% plain lidocaine solution directly through the penile skin circumferentially around the proximal third of the penis. All men underwent circumcision using the Shang Ring and were evaluated for anesthetic safety, efficacy and acceptability. Pain was measured on a visual analog scale. RESULTS The average volume of 2% lidocaine anesthetic solution delivered by jet injection was 0.1 ml with a mean total of 0.9 ml per circumcision procedure. More than 85% of men did not require supplemental anesthesia. Anesthetic onset required approximately 45 seconds from the time that injections were completed. Mean pain scores for immediate postoperative, 24-hour postoperative, ring removal and post-ring removal events were 0.1, 6.8, 2.2 and 0.9, respectively. In 4 patients (6.67%) mild urethral bleeding resolved with pressure, resulting in technique modification. CONCLUSIONS No-needle jet injection is safe and effective for adult MC. The technique efficiently delivers local anesthesia with rapid onset in men undergoing circumcision. This needle-free approach may enhance the popularity of adult male circumcision.
Collapse
Affiliation(s)
- Yifeng Peng
- Department of Sexual Medicine, Yijishan Hospital-Wannan Medical College, Wuhu, People's Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Hogan ME, Kikuta A, Taddio A. A systematic review of measures for reducing injection pain during adult immunization. Vaccine 2009; 28:1514-21. [PMID: 20003927 DOI: 10.1016/j.vaccine.2009.11.065] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 11/06/2009] [Accepted: 11/20/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of different pain-relieving interventions to reduce pain from immunization in adults. DATA SOURCES MEDLINE (1950 to October Week 3 2008) PsycINFO (1967 to December Week 1 2008), CINAHL (1982 to October Week 4 2008), EMBASE (1980 to 2008 Week 43) and the Cochrane Central Register of Controlled Trials (3rd Quarter 2008). REVIEW METHODS Databases were searched for trials of pharmacological, behavioural, physical or operator-dependant techniques to reduce pain from immunization in adults. The primary outcome was pain as assessed by visual analogue scale or other numeric rating scale. RESULTS Six studies representing 853 participants were identified. One study evaluating pharmacological interventions (lidocaine-prilocaine) found them to be effective in reducing pain from immunization. Similarly, two studies evaluating physical pain relieving techniques, either skin cooling interventions (Fluori-Methane) or tactile stimulation (manual pressure at the site of injection) found them to reduce pain. One study of jet injectors found them to be more painful than conventional needle and syringe. Neither freezing needles nor warming vaccines was found to be effective in reducing pain. No studies investigated psychological interventions or oral analgesics (acetaminophen and ibuprofen). CONCLUSION There was limited evidence to support the use of lidocaine-prilocaine, Fluori-Methane and manual pressure for reducing immunization pain in adults. There was limited evidence of more pain with jet injectors compared to needle and syringe. Due to limited data, we recommend further investigation of methods to reduce immunization pain in adults, primarily psychological and physical techniques.
Collapse
Affiliation(s)
- Mary-Ellen Hogan
- Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | | | | |
Collapse
|
6
|
Gursoy A, Ertugrul DT, Sahin M, Tutuncu NB, Demirer AN, Demirag NG. Needle-free delivery of lidocaine for reducing the pain associated with the fine-needle aspiration biopsy of thyroid nodules: time-saving and efficacious procedure. Thyroid 2007; 17:317-21. [PMID: 17465861 DOI: 10.1089/thy.2006.0326] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Fine-needle aspiration biopsy (FNAB) is a mandatory procedure in evaluation of thyroid nodules. However, it is sometimes perceived as a painful procedure by the patients. Efficacy of the needle-free injection of local anesthesia for reducing the pain associated with other cutaneous procedures that involve needle insertion was previously reported. In this double-blind, placebo-controlled clinical trial, we evaluated the effectiveness of a needle-free injection of lidocaine in achieving satisfactory pain control in patients undergoing FNAB of thyroid nodules. DESIGN Patients were allocated to receive either lidocaine administered by needle-free injection system (n = 55) or placebo (isotonic saline) (n = 52) 2-3 minutes before FNAB. A series of four aspirations of each nodule was performed. The patients rated pain associated with the procedure according to a 100-mm visual analog scale (VAS), an 11-point numeric rating scale (NRS), and a four-category verbal rating scale (VRS). MAIN OUTCOME MEASURE The two groups studied were similar with respect to age, sex, thyroid volume, nodule size, and nodule site. When the effectiveness of lidocaine was compared with that of placebo, the mean VAS score was 11.4 +/- 13.6 mm versus 38.2 +/- 35.5 mm (p < 0.0001) and the mean NRS score was 1.4 +/- 1.5 points versus 3.9 +/- 2.6 points (p < 0.0001), respectively. The absolute numbers according to VRS score in each group was also significantly different (p < 0.0001). The percentage of patients with "no pain" or "mild pain" in the lidocaine group (90.9%) was significantly higher than that in the placebo group (44.2%) (p < 0.0001). Less than 10% of the patients in lidocaine group experienced moderate pain and none experienced severe pain. No adverse treatment-related effects were observed. CONCLUSIONS To our knowledge, this is the first study demonstrating that the needle-free delivery of lidocaine is an effective, useful, and noninvasive method of providing local anesthesia for the FNAB of thyroid nodules.
Collapse
Affiliation(s)
- Alptekin Gursoy
- Department of Endocrinology and Metabolism, Baskent University Faculty of Medicine, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
7
|
Benohanian A. Needle-free anaesthesia prior to botulinum toxin type A injection treatment of palmar and plantar hyperhidrosis. Br J Dermatol 2007; 156:593-6. [PMID: 17300264 DOI: 10.1111/j.1365-2133.2007.07691.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Benohanian A. Needle-free anesthesia: a promising technique for the treatment of palmoplantar hyperhidrosis with botulinum toxin A. ACTA ACUST UNITED AC 2006. [DOI: 10.2217/14750708.3.5.591] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
9
|
Abstract
PURPOSE We describe a new, modified jet injection technique for local anesthesia for no-scalpel vasectomy without the use of a needle, which may minimize the fear of vasectomy in men due to the needle involved in local anesthesia. MATERIALS AND METHODS A MadaJet Medical Injector (MADA Medical Products, Carlstadt. New Jersey) was used in this study to deliver a high pressure spray of 0.1 cc local anesthetic solution directly through the scrotal skin down onto the tissue around the vas. Two or 3 jet injections are delivered to each vas and a total of 4 to 6 suffice for the entire vasectomy. RESULTS No-needle jet injection is remarkably effective for local anesthesia for no-scalpel vasectomy. The average volume of anesthetic solution per jet injection is 0.1 cc with 0.2 to 0.3 cc for each vas. Onset is almost immediate, within 10 to 20 seconds after injection. About 465 patients were anesthetized by the jet injection technique with great satisfaction. The average visual analog scale score for the pain of the jet injection itself was 1.71 of 10. The average visual analog scale score for the pain of subsequent vasectomy during the surgical procedure was 0.66 of 10 (median 0.2). No hematomas were noted. Patients experience the mild discomfort of a pinch, not unlike a rubber band, with the first injection. CONCLUSIONS No-needle anesthesia with jet injection is a new technique to deliver rapid onset of profound local anesthesia to the patient undergoing vasectomy. It is a simple and safe approach with high patient satisfaction, as reflected in low pain scores. The benefit of this technique without a needle is that it may decrease the fear of pain in men and enhance the popularity of vasectomy worldwide.
Collapse
Affiliation(s)
- Ronald S Weiss
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
| | | |
Collapse
|
10
|
Peter DJ, Scott JP, Watkins HC, Frasure HE. Subcutaneous lidocaine delivered by jet-injector for pain control before IV catheterization in the ED: the patients' perception and preference. Am J Emerg Med 2002; 20:562-6. [PMID: 12369033 DOI: 10.1053/ajem.2002.35493] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To evaluate patients' perceptions and preferences concerning pain control during intravenous (IV) catheterization, a sample of 50 adult patients received subcutaneous lidocaine (0.2 mL 1%) by jet injector, or no anesthetic with a sham injection before IV catheterization. Visual analog scale (VAS), pain intensity score (PIS), and adverse reactions were recorded. A significant difference existed in the scores of patients who received lidocaine versus those who did not VAS (P <.001) PIS (P <.004). Patients' receiving lidocaine via jet-injector experienced more minor and potentially preventable adverse effects such as mild bruising and trauma to the veins. Patients in both groups (84% overall) preferred local anesthesia based on this experience. Using the jet-injector to provide local anesthesia before IV catheterization in the ED is effective, fast, and does not require sharps disposal and handling precautions.
Collapse
Affiliation(s)
- David J Peter
- Department of Emergency Medicine, Akron General Medical Center, Akron, OH 44307, USA.
| | | | | | | |
Collapse
|
11
|
Weintraub AM, Ponce de Leon MP. Potential for cross-contamination from use of a needleless injector. Am J Infect Control 1998; 26:442-5. [PMID: 9721400 DOI: 10.1016/s0196-6553(98)70043-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medical devices that are used on patients in fields containing potentially infectious body fluids can become contaminated and transmit infectious agents to other sites on the patient or to other patients if the devices are not properly cleaned and decontaminated after use on each patient treatment site. One such device is the needleless or jet injector, which is widely used in medicine and dentistry to deliver local anesthetic in procedures such as bone marrow aspirations, lumbar punctures, and cutaneous and intraoral injections. This study was conducted to determine whether cross-contamination can occur on in vitro reuse of a needleless injector and whether a manufacturer's recommended method of injector decontamination (ie, immersion sterilization) is effective in the prevention of cross-contamination. METHODS The study was performed with new autoclaved injectors, fluorescein dye, and Streptococcus crista (the bacteria commonly found in saliva) in the field of use to determine whether these devices can become contaminated during use and carry over the contamination to other sites during immediate reuse. RESULTS Fluorescein dye and bacteria tests with the needleless injectors showed that contamination or carryover does occur. It appeared to reduced to a minimum when a autoclaved, sterile rubber cap used over the head of the device during injection was replaced between each use, although replacement of the rubber cap alone did not prevent carryover. Immersion of the head of the injector in a 2% glutaraldehyde solution for 30 minutes followed by a sterile water rinse and the replacement of the rubber cap with a sterile cap between uses was shown to curtail bacterial growth and prevent cross-contamination on immediate reuse of the device. CONCLUSION This study demonstrated that needleless injectors become contaminated during in vitro use and direct contact with contaminated surfaces and that needless injectors carry over the contamination to subsequent sites of release. The replacement of the injector's rubber cap with a new one after initial discharge or the removal of an exposed rubber cap and immersion of the head of the injector in 2% glutaraldehyde followed by a rinse of the head in sterile water, as recommended by one injector manufacturer, can minimize or eliminate the carryover.
Collapse
Affiliation(s)
- A M Weintraub
- Office of Clinic Management and Patient Services, University of Pennsylvania School of Dental Medicine, Philadelphia 19104-6003, USA
| | | |
Collapse
|
12
|
Seyam RM, Bégin LR, Tu LM, Dion SB, Merlin SL, Brock GB. Evaluation of a no-needle penile injector: a preliminary study evaluating tissue penetration and its hemodynamic consequences in the rat. Urology 1997; 50:994-8. [PMID: 9426740 DOI: 10.1016/s0090-4295(97)00541-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Intracavernous needle injection is an effective delivery method for pharmacotherapy of erectile dysfunction. Needle phobia, pain, and concern about local tissue injury have stimulated the search for new, less invasive means of inducing penile erection. In this preliminary communication, we evaluate a jet injector as an alternative to needle injection for intracavernous delivery of vasoactive drugs. METHODS Jet injection was evaluated in three groups of rats receiving either India ink, saline, or papaverine into the penis. The ability of the jet injection to penetrate through the tunica albuginea and deliver liquid to the corpora cavernosa smooth muscle was assessed by the degree of staining within the corpus cavernosum (ink group), histologic change (saline group), and rise in intracavernous pressure (papaverine group). Erectile capacity following cavernous nerve electric stimulation was compared before and 1 hour after injection of saline or papaverine. RESULTS Ink traversed the skin and tunica albuginea with extensive deposition noted within the cavernous spaces. Varying degree of subcutaneous hemorrhage were seen with saline jet injection; however, the corpus cavernous smooth muscles showed no evidence of injury. Jet injection of papaverine 3250 micrograms significantly increased cavernous pressure (39.4 +/- 4.6 cm H2O) compared with saline injection (2.8 +/- 1.3 cm H2O). CONCLUSIONS We conclude that acute jet injection is an effective method for intracavernous delivery of drugs. Long-term effects should be evaluated prior to clinical use.
Collapse
Affiliation(s)
- R M Seyam
- Division of Urology, McGill University, Montreal, Québec, Canada
| | | | | | | | | | | |
Collapse
|