An Exploratory Study of Patient Preferences for Pain Management During Intravenous Insertion: Maybe We Should Sweat the Small Stuff

Factors Influencing Nurses' Use of Local Anesthetics for Venous and Arterial Access

The use of local anesthetics to relieve pain associated with intravenous cannulation and arterial blood gas sampling is given low priority in many health institutions. This review sought to identify factors influencing nurses' use of local anesthetics for these procedures. The Database Syntax Guide for Systematic Reviewers was used; health-relevant studies were critically assessed with appropriate Critical Appraisal Skills Programme tools. Significant factors influencing the use of local anesthetics for parenteral procedures were identified, including the level of effectiveness among types of local anesthetics, the perceived benefits of facilitating needle insertions and patient satisfaction, the underestimation of pain associated with needle punctures, time concerns, physician authorization, and costs.

First do no harm: pain relief for the peripheral venous cannulation of adults, a systematic review and network meta-analysis

BACKGROUND

Peripheral venous cannulation is an everyday practice in hospitals, which many adults find painful. However, anaesthesia for cannulation is usually only offered to children. Inadequate pain relief is not only unpleasant for patients but may cause anxiety about further treatment and deter patients from seeking medical care in the future. The aim of this study is to discover the most effective local anaesthetic for adult peripheral venous cannulation and to find out how the pain of local anaesthetic application compares with that of unattenuated cannulation.

METHODS

These aims are addressed through a systematic review, network meta-analysis and random-effects meta-analysis. Searching covered 12 databases including MEDLINE and EMBASE from 1990 to August 2015. The main included study design was RCTs. The primary outcome measure is self-reported pain, measured on a 100 mm visual analogue scale.

RESULTS

The systematic review found 37 includable studies, 27 of which were suitable for network meta-analysis and two for random-effects meta-analysis. The results of the network meta-analysis indicate that none of the 17 anaesthetic considered had a very high probability of being the most effective when compared to each other; 2 % lidocaine had the highest probability (44 %). When the anaesthetics were compared to no treatment, the network meta-analysis showed that again 2 % lidocaine was estimated to be the most effective (mean difference -25.42 (95 % CI -32.25, -18.57). Other members of the 'caine' family were also estimated to be more effective than no treatment as were Ametop®, EMLA® and Rapydan® patch. The meta-analysis compared the pain of anaesthetic application with the unattenuated pain of cannulation. This found that all applications of local anaesthetic were less painful than cannulation without local anaesthetic. In particular a 1 % lidocaine injection was estimated to be -12.97 (95 % CI -15.71, -10.24) points (100 mm VAS) less painful than unattenuated cannulation.

CONCLUSIONS

The pain of peripheral venous cannulation in adults can be successfully treated. The pain of application of any local anaesthetic is less than that of unattenuated cannulation. Local anaesthetic prior to cannulation should become normal practice and a marker of high quality care.

PROTOCOL REGISTRATION

The protocol for the larger study was registered with PROSPERO no. CRD42012002093 .

Will Patients Perceive a Numbing Spray to Be an Effective Method of Anesthetizing an Intravenous Site?

PURPOSE

The purpose of this study was to determine if patients would perceive a numbing spray to be an effective method of anesthetizing an intravenous (IV) site.

DESIGN

A quasi-experimental design was used.

METHODS

The first 50 patients were given no pain management strategy before their IV insertion, and the next 50 patients were given a numbing spray.

FINDINGS

The hypothesis that pain scores reported from the numbing spray group would be less than pain scores reported from the non-numbing spray group was not supported.

CONCLUSION

The numbing spray is an effective method of anesthetizing an IV site based on both groups' responses to the other research questions. Both groups indicated they would try a numbing spray with future IV insertions, would prefer a numbing spray over a numbing injection, and were satisfied with their IV insertion. Patients wanted a less intrusive method than intradermal lidocaine.

Simple Psychological Interventions for Reducing Pain From Common Needle Procedures in Adults: Systematic Review of Randomized and Quasi-Randomized Controlled Trials

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.