The Effect of Combined Stimulation of External Cold and Vibration During Immunization on Pain and Anxiety Levels in Children

Effectiveness and safety of Buzzy device in needle-related procedures for children under twelve years of age: A systematic review and meta-analysis

BACKGROUND

Pain transcends simple physiology, encompassing biological, emotional, psychological, and social facets. Children show pronounced immediate and enduring responses to pain-related procedures. The aim of this meta-analysis is to investigate the efficacy and safety of the Buzzy device for needle-related procedures in children aged twelve years or younger.

METHODS

PubMed, Web of Science, and Embase were searched from inception to July 2023. Only randomized controlled trials utilizing the Buzzy device for needle-related procedures in children under twelve years old were included. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment. Random-effects models were utilized, and analyses were performed using mean differences or standardized mean differences as well as risk ratios.

RESULTS

A total of 19 studies were included, involving 2846 participants (Buzzy = 1095, Control = 1751). Compared to no intervention, the Buzzy device significantly reduced pain response [self-report SMD = -1.90 (-2.45, -1.36), parental SMD = -3.04 (-4.09, -1.99), observer SMD = -2.88 (-3.75, -2.02)] and anxiety scores [self-report SMD = -1.97 (-3.05, -0.88), parental SMD = -2.01 (-2.93, -1.08), observer SMD = -1.92 (-2.64, -1.19)]. Compared to virtual reality (VR), the Buzzy device reduced self-reported anxiety levels SMD = -0.47 (-0.77, -0.17), and compared to distraction cards, the Buzzy device reduced parental and observer-reported pain [parental SMD = -0.85 (-1.22, -0.48), observer SMD = -0.70 (-1.00, -0.40)] and anxiety [parental SMD = -0.96 (-1.46, -0.47), observer SMD = -0.91 (-1.40, -0.42)]. Subgroup analysis results showed that procedure type, patient age, measurement scales used, and distance of operation were not the reason of heterogeneity. The summarized first puncture attempt success rate did not differ from other interventions. There were no significant adverse events in the included studies.

CONCLUSION

The Buzzy device reduces pain and anxiety in children during needle procedures, ensuring success and safety. Additionally, the effectiveness of the Buzzy device in reducing pain during venipuncture is superior when compared to its effectiveness during intramuscular injections.

The Effect of a Combination of Vibration and External Cold on Pain Caused during Vaccine Injection in Infants: A Randomized Clinical Trial

Aim

This study was conducted to determine the effect of combining vibration and external cold on pain caused by vaccine injection among six-month-old infants.

Design

Randomized controlled trial.

Methods

In this clinical trial, 80 eligible infants were selected from the infants referred to a health center as per the inclusion criteria. The infants were assigned to either a control group or an intervention group by block randomization. In the intervention group, a vibrating and cold device was placed above the injection site from one minute before to 15 seconds after the pentavalent vaccine injection. In the control group, no intervention was performed, and they were vaccinated according to the routine procedure. The pain status in the two groups was measured using the Modified Behavioral Pain Scale (MBPS) 15 seconds after the injection, and the crying duration was assessed from the injection of the vaccine till the end of it. Data were analyzed in SPSS 23 software using Mann-Whitney, t, Spearman, and chi-square tests. The level of significance was set to p < 0.05.

Results

Most participants in the control (55%) and intervention (55%) groups were girls. Statistical data analysis of 80 infants showed that the mean pain intensity (p = 0.032) and duration of crying (p = 0.0001) in the intervention group (6.1 ± 1.8, 32.47 ± 16.78) were lower than those of the control group (7.2 ± 0.1, 51.02 ± 25.9), respectively.

Conclusion

Because the intensity of pain, especially the duration of crying, was lower in the intervention group than in the control group, we may suggest that nurses use simple pain relief solutions in vaccination centers, such as a combination of vibration and cold. This trial is registered with IRCT201207157130N2.

The effect of visual and/or auditory distraction techniques on children's pain, anxiety and medical fear in invasive procedures: A randomized controlled trial

PURPOSE

This study was conducted to determine the effects of visual and/or auditory distraction techniques applied to children aged 7-12 during invasive procedures on pain, anxiety, and medical fear.

METHODS

This single-blinded, randomized controlled trial was carried out in the pediatric emergency department of a public hospital between November 2021 and March 2022. In the study, 144 children were assigned to three different intervention groups, in which a kaleidoscope, music, and virtual reality were applied during invasive procedures, and the control group in which the standard invasive procedure was applied, by using the stratified block randomization method. The data were collected using a Personal Information Form, Wong-Baker Faces Pain Rating Scale, Children's Anxiety Meter-State, and Child Medical Fear Scale.

RESULTS

In the study, the levels of pain, anxiety, and medical fear after the invasive procedure were lower in the intervention groups than in the control group. In addition, there was no difference between the three different distraction techniques in terms of reducing pain and medical fear, but the virtual reality application was more effective in reducing the level of anxiety.

CONCLUSION

Visual and/or auditory distraction techniques are effective methods that can be used by nurses in pediatric healthcare to reduce invasive procedure-related pain, anxiety, and medical fear.

IMPLICATIONS FOR PRACTICE

This study provides evidence that can guide the use of non-pharmacological methods such as distraction to prevent the traumatic effects of invasive procedures in children.

The effect of auditory stimuli on the pain and physiological parameters of children on mechanical ventilation during aspiration procedure: A randomized controlled trial

PURPOSE

The study was conducted to determine the effect of mother's voice and music sound on pain and physiological parameters during aspiration procedure in children with mechanical ventilation support in the pediatric intensive care unit.

DESIGN AND METHODS

This study was a randomized controlled type experimental study. According to the power analysis result of the sample of the study, 84 children who were treated in the pediatric intensive care unit of two university hospitals in Istanbul were formed. Introductory Information Form, Ramsey Sedation Scale, Physiological Parameter Form and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were used to collect data.

RESULTS

When the pain results of the children were evaluated, the mean FLACC Pain Scale value of the children in the control group was found to be significantly higher than children in the mother's voice and music voice group (p < 0.05). It was determined that the lowest FLACC Pain Scale value was in the mother's voice group (p < 0.05). When the physical parameter results were evaluated, it was determined that the physiological measurement values of the children in the experimental group were positively affected (p < 0.05), there was a significant difference between the control group (p < 0.05) and the most effective result was in the mother's voice group (p < 0.05).

PRACTICE IMPLICATIONS

Allowing children to listen mother's voice and music during aspiration procedure reduces pain of the children, positively affects their physical parameter values and enhances quality of nursing care. The results of this study create a scientific basis for nursing practices in the clinical settings and contribute to the clinical practices by shedding a light on future evidence-based studies.

The Effectiveness of the Buzzy Device in Reducing Pain in Children Undergoing Venipuncture: A Single-Center Experience

OBJECTIVES

Needle-related procedures are among the most important sources of pain in children in different health care settings. Our study was aimed to evaluate the effectiveness of Buzzy (MMJ Labs, Atlanta, Ga.), a palm-sized bee/ladybug-shaped device combining vibration and cold, as a nonpharmacological strategy to manage needle-related pain in children.

METHODS

In this single-center, randomized (1:1) controlled open-label study, we enrolled patients aged from 1 month to 18 years who had to undergo a planned outpatient blood sampling in Pisa University Hospital's Department of Pediatrics and randomly allocated them to either the BUZZY group (intervention group) or NO BUZZY group (control group). Pain was estimated using proper pain scales according to age.

RESULTS

Between May 2021 and January 2022, 234 children aged 8.8 ± 5.1 years (50.8% girls) were enrolled and 117 were treated with the Buzzy device. In the study population, pain inversely correlated with age (r = -0.52, P < 0.001); the intervention group showed significantly lower pain (2.5 ± 2.4 vs 4.7 ± 2.8, P < 0.001) and no difference was found between boys and girls. Significant reduction in pain scores was confirmed when stratifying children by age (29 days to <3 years, P = 0.002; ≥3 to ≤8 years, P < 0.001; >8 years, P < 0.001).

CONCLUSIONS

The Buzzy device effectively reduces pain caused by percutaneous antecubital venipuncture in children in different age groups and represents a cheap and easy-to-use strategy to manage routine needle-related procedures.

Efficacy of an external cold and vibrating device in reducing discomfort during the administration of an inferior alveolar nerve block in children: A split-mouth randomised crossover study

Background: Local anaesthesia is the backbone of pain management. However, the administration of a local anaesthetic injection itself is considered a painful procedure and triggers fear and anxiety in the patient. Methods: A split-mouth randomised controlled crossover trial was designed to study the efficacy of an "external cold and vibrating" device in reducing discomfort during the administration of an inferior alveolar nerve block (IANB) in children. A total of 40 children who fulfilled the inclusion criteria were evaluated for pain response following administration of IANB with and without the "external cold and vibrating" device. Randomisation was performed to determine whether the subject received the control intervention first or the test intervention first. The intensity of the pain response and discomfort were recorded using the Wong-Baker FACES Pain Rating Scale and the Faces Legs Activity Cry and Consolability scale. Results: There was a statistically significant difference in the pain response between the test group and the control group (p<0.001). Females reported a higher pain response than males, with a statistically significant difference, when the FLACC scores were compared. Conclusions: The "external cold and vibrating" device reduced discomfort during the administration of an IANB in children selected for the study.

Non-pharmacological management of infant and young child procedural pain

BACKGROUND

Despite evidence of the long-term implications of unrelieved pain during infancy, it is evident that infant pain is still under-managed and unmanaged. Inadequately managed pain in infancy, a period of exponential development, can have implications across the lifespan. Therefore, a comprehensive and systematic review of pain management strategies is integral to appropriate infant pain management. This is an update of a previously published review update in the Cochrane Database of Systematic Reviews (2015, Issue 12) of the same title.

OBJECTIVES

To assess the efficacy and adverse events of non-pharmacological interventions for infant and child (aged up to three years) acute pain, excluding kangaroo care, sucrose, breastfeeding/breast milk, and music.

SEARCH METHODS

For this update, we searched CENTRAL, MEDLINE-Ovid platform, EMBASE-OVID platform, PsycINFO-OVID platform, CINAHL-EBSCO platform and trial registration websites (ClinicalTrials.gov; International Clinical Trials Registry Platform) (March 2015 to October 2020). An update search was completed in July 2022, but studies identified at this point were added to 'Awaiting classification' for a future update.  We also searched reference lists and contacted researchers via electronic list-serves.  We incorporated 76 new studies into the review.  SELECTION CRITERIA: Participants included infants from birth to three years in randomised controlled trials (RCTs) or cross-over RCTs that had a no-treatment control comparison. Studies were eligible for inclusion in the analysis if they compared a non-pharmacological pain management strategy to a no-treatment control group (15 different strategies). In addition, we also analysed studies when the unique effect of adding a non-pharmacological pain management strategy onto another pain management strategy could be assessed (i.e. additive effects on a sweet solution, non-nutritive sucking, or swaddling) (three strategies). The eligible control groups for these additive studies were sweet solution only, non-nutritive sucking only, or swaddling only, respectively. Finally, we qualitatively described six interventions that met the eligibility criteria for inclusion in the review, but not in the analysis.  DATA COLLECTION AND ANALYSIS: The outcomes assessed in the review were pain response (reactivity and regulation) and adverse events. The level of certainty in the evidence and risk of bias were based on the Cochrane risk of bias tool and the GRADE approach. We analysed the standardised mean difference (SMD) using the generic inverse variance method to determine effect sizes.  MAIN RESULTS: We included total of 138 studies (11,058 participants), which includes an additional 76 new studies for this update. Of these 138 studies, we analysed 115 (9048 participants) and described 23 (2010 participants) qualitatively. We described qualitatively studies that could not be meta-analysed due to being the only studies in their category or statistical reporting issues. We report the results of the 138 included studies here. An SMD effect size of 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect. The thresholds for the I2 interpretation were established as follows: not important (0% to 40%); moderate heterogeneity (30% to 60%); substantial heterogeneity (50% to 90%); considerable heterogeneity (75% to 100%). The most commonly studied acute procedures were heel sticks (63 studies) and needlestick procedures for the purposes of vaccines/vitamins (35 studies). We judged most studies to have high risk of bias (103 out of 138), with the most common methodological concerns relating to blinding of personnel and outcome assessors. Pain responses were examined during two separate pain phases: pain reactivity (within the first 30 seconds after the acutely painful stimulus) and immediate pain regulation (after the first 30 seconds following the acutely painful stimulus). We report below the strategies with the strongest evidence base for each age group. In preterm born neonates, non-nutritive sucking may reduce pain reactivity (SMD -0.57, 95% confidence interval (CI) -1.03 to -0.11, moderate effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.61, 95% CI -0.95 to -0.27, moderate effect; I2 = 81%, considerable heterogeneity), based on very low-certainty evidence. Facilitated tucking may also reduce pain reactivity (SMD -1.01, 95% CI -1.44 to -0.58, large effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.59, 95% CI -0.92 to -0.26, moderate effect; I2 = 87%, considerable heterogeneity); however, this is also based on very low-certainty evidence. While swaddling likely does not reduce pain reactivity in preterm neonates (SMD -0.60, 95% CI -1.23 to 0.04, no effect; I2 = 91%, considerable heterogeneity), it has been shown to possibly improve immediate pain regulation (SMD -1.21, 95% CI -2.05 to -0.38, large effect; I2 = 89%, considerable heterogeneity), based on very low-certainty evidence. In full-term born neonates, non-nutritive sucking may reduce pain reactivity (SMD -1.13, 95% CI -1.57 to -0.68, large effect; I2 = 82%, considerable heterogeneity) and improve immediate pain regulation (SMD -1.49, 95% CI -2.20 to -0.78, large effect; I2 = 92%, considerable heterogeneity), based on very low-certainty evidence.  In full-term born older infants, structured parent involvement was the intervention most studied. Results showed that this intervention has little to no effect in reducing pain reactivity (SMD -0.18, 95% CI -0.40 to 0.03, no effect; I2 = 46%, moderate heterogeneity) or improving immediate pain regulation (SMD -0.09, 95% CI -0.40 to 0.21, no effect; I2 = 74%, substantial heterogeneity), based on low- to moderate-certainty evidence. Of these five interventions most studied, only two studies observed adverse events, specifically vomiting (one preterm neonate) and desaturation (one full-term neonate hospitalised in the NICU) following the non-nutritive sucking intervention. The presence of considerable heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of evidence of very low to low certainty based on GRADE judgements.

AUTHORS' CONCLUSIONS

Overall, non-nutritive sucking, facilitated tucking, and swaddling may reduce pain behaviours in preterm born neonates. Non-nutritive sucking may also reduce pain behaviours in full-term neonates. No interventions based on a substantial body of evidence showed promise in reducing pain behaviours in older infants. Most analyses were based on very low- or low-certainty grades of evidence and none were based on high-certainty evidence. Therefore, the lack of confidence in the evidence would require further research before we could draw a definitive conclusion.

Registered Nurses' Association of Ontario (RNAO) best practice guideline on the assessment and management of vascular access devices

INTRODUCTION

Vascular access is the most common invasive procedure performed in health care. This fundamental procedure must be performed in a safe and effective manner. Vascular access devices (VADs) are often the source of infections and other complications, yet there is a lack of clear guidance on VADs for health providers across different settings. A Best Practice Guideline (BPG) was developed by the Registered Nurses' Association of Ontario (RNAO) to provide evidence-based recommendations on the assessment and management of VADs.

METHODS

RNAO BPGs are based on systematic reviews of the literature following the GRADE approach. Experts on the topic of vascular access were selected to form a panel. Systematic reviews were conducted on six research areas: education, vascular access specialists, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. A search for relevant research studies published in English limited to January 2013 was applied to eight databases. All studies were independently assessed for eligibility and risk of bias by two reviewers based on predetermined inclusion and exclusion criteria. The GRADE approach was used to determine certainty of the evidence.

RESULTS

Over 65,000 articles were screened related to the six priority research questions. Of these, 876 full-text publications were examined for relevance, with 174 articles designated to inform nine recommendations in the BPG on the subject areas of: comprehensive health teaching, practical education for health providers, blood draws, daily review of peripheral VADs, visualization technologies, and pain management. In June 2021, the RNAO published the BPG on vascular access, which included the recommendations and other supporting resources.

CONCLUSION

The vascular access BPG provides high quality guidance and updated recommendations, and can serve as a primary resource for health providers assessing and managing VADs.

The Effect of Virtual Reality and Buzzy on First Insertion Success, Procedure-Related Fear, Anxiety, and Pain in Children during Intravenous Insertion in the Pediatric Emergency Unit: A Randomized Controlled Trial

INTRODUCTION

Distraction methods such as virtual reality and cold vibration device are recommended during intravenous interventions. Few studies have focused on the impact of nonpharmacological interventions on intravenous insertion success.

METHODS

A randomized controlled study evaluated effect of virtual reality and cold vibration device application on first-attempt intravenous insertion success and procedure-related pain, fear, and anxiety during intravenous insertion in children. Children aged 4 to 10 years (N = 150) undergoing peripheral intravenous catheterization insertion in the pediatric emergency department were randomized to 1 of 3 groups: virtual reality, cold vibration (Buzzy), and control group. Distraction technique of talking and asking questions of children was used in control group. Primary outcome was first-attempt intravenous insertion success; secondary outcomes were procedure-related pain, fear, and anxiety. Study data were collected using Difficult Intravenous Access score, Emotional Appearance Scale for Children, Wong-Baker Faces Pain Rating Scale, Color Analog Scale, Children's Anxiety Meter-State, and Child Fear Scale. Data were analyzed using chi-square test, Fisher exact test, and Kruskal-Wallis test.

RESULTS

There were no significant differences in first-attempt intravenous insertion success rates (virtual reality = 47.2%, Buzzy® = 50%, control = 46.9%), preprocedural emotional appearance scores, and procedure-related pain and anxiety scores. There was no difference between groups for vital signs before, during, and at fifth minute of procedure.

DISCUSSION

Virtual reality and Buzzy may decrease procedure-related fear in children during intravenous insertion. This research has shown that pediatric emergency nurses can reduce pain and anxiety by talking to children, and simple distractions such as asking questions are as effective as more technological ones.

The Effect of Buzzy Application on Pain Level During Vaccine Injection in Infants

BACKGROUND

Nonpharmacological interventions are needed to reduce pain during vaccine administration in infants.

PURPOSE

To determine the effect of the Buzzy device, which is a combination of cold and vibration, on pain during measles-mumps-rubella (MMR) vaccine administration in 12-month-old infants.

METHODS

A prospective randomized controlled experimental research design was used.

RESULTS

A total of 60 infants were included in the study. During and after vaccine injection, pain scores of infants who had the Buzzy device were significantly lower than those of infants in the control group ( P = .001).

CONCLUSIONS

Buzzy application may be an effective method in reducing pain during MMR vaccine administration. Use of the device is recommended for infants receiving vaccinations.

Development and refinement of Rel@x:A training in hypnosis-derived communication for pediatric nurses to prevent procedural pain

Introduction

Studies in pediatric oncology have shown that hypnosis effectively reduces patients' pain and distress during painful procedures. This remains underutilized in the healthcare system due to the staff cost and availability of hypnotherapists. To develop the use of hypnosis-derived communication, we aimed to train nurses to use hypnosis-derived communication while they perform painful procedures.

Objectives

This study aimed to (1) develop a brief training in hypnosis-derived communication for pediatric nurses named Rel@x, (2) pretest the training with experienced pediatric oncology nurses, and (3) refine the training based on nurses' suggestions.

Methods

The Rel@x training consists of two 4-h sessions: one related to relational aspects and another one presenting one of two selected hypnotic communication techniques ("pleasant place" or "magic glove"). Rel@x makes use of manuals, cue card reminders, visual aids, videos, and an e-learning platform. To refine Rel@x, a complete training cycle was conducted with seven female pediatric oncology nurses. A mixed method study with an evaluation questionnaire and a post-training focus group interview was conducted.

Results

Quantitative data showed that nurses overall positively rated the training program: relevance and acceptability (median average of 5.4/6); use of hypnotic communication (median average of 5.2/6); expected effects (median average of 5.4/6); program implementation (5.6/6). Two general themes emerged from the qualitative data: perceptions of hypnotic communication and the evaluation of the Rel@x training program. Based on nurses' suggestions, Rel@x was refined by adding more practical components, more time for practice, more time between the two sessions and additional tools (cue card reminders, keywords, virtual e-learning recap module).

Conclusion and clinical implications

The use of hypnosis-derived communication during painful procedures and the Rel@x training were viewed favorably amongst pediatric nurses. Rel@x offers a complete training in hypnosis-derived communication for pediatric nurses. This training fosters the optimal use of hypnosis-derived communication during care and may significantly reduce children's procedural pain and distress.

Effect of using vacutainers with cartoon characters on the pain and fear levels of preschoolers during bloodletting

AIM

Our study aims to analyse the effect of using a vacutainer with cartoon characters on preschoolers' pain and fear levels during the bloodletting process.

METHODS

The experimental, randomised controlled clinical trial was conducted with 102 children aged 3-6 years, randomised into control and experimental groups. The bloodletting routine was applied to the control group. The vacutainer of each child in the experimental group was covered with the illustration of their chosen cartoon character and blood was drawn with it. The fear and pain levels during the bloodletting procedure were examined in both groups.

RESULTS

Pain and fear levels were significantly lower in the experimental group than in the experimental group (P < 0.05).

CONCLUSIONS

Our research highlighted that using a cartoon character sticker with a vacutainer can reduce preschoolers' pain and fear during bloodletting.

Comparative Study of the Effect of Lidocaine Spray and Ice Spray on the Pain Intensity During Intramuscular Injection: A Randomized Clinical Trial

BACKGROUND

Intramuscular injection is one of the most common, invasive, and painful ways to deliver medicine to the body.

AIM

Since one of the nurse's duties is to employ different methods to reduce pain caused by treatment procedures, this study was conducted to determine the effect of lidocaine spray and ice spray on pain intensity at the muscle injection site.

METHOD

A clinical trial was performed on 90 patients presenting to outpatient clinics of Neyshabur hospitals. The samples were selected using a computerized table of random numbers, and each participant was randomly assigned to one of the control, lidocaine spray, and ice spray groups. Pain severity was measured immediately after intramuscular injection using a numerical pain scale. Descriptive statistics along with statistical tests (chi-square, Fisher, etc.) were used to analyze the data in the R environment version 3.6.2. Ordinal logistic regression was used to compare pain intensity in the three groups by adjusting the effect of age variables and sensory disorders.

RESULTS

The mean pain intensity was 3.44 without intervention, 2.63 with lidocaine spray, and 2.27 with ice spray. Statistical tests indicated a significant difference in pain intensity of intramuscular injection between the ice group and the control group (p = .010). Although lidocaine spray reduced the pain intensity, its effect was insignificant compared with the control group.

CONCLUSIONS

Both ice and lidocaine spray can be effectively used to reduce the intensity of intramuscular injection pain; however, it seems that ice spray is a more effective, safe, and affordable method.

Vapocoolant Spray for Pain Control in Intramuscular Injection Applications: A Prospective, Randomized Controlled Trial

Background Many pharmacological and nonpharmacological methods have been investigated along with advances in pain treatment. One of these nonpharmacological methods is the use of vapocoolant spray.

Objective This study aimedto demonstrate the effectiveness of vapocoolant spray to reduce pain during intramuscular (IM) injection.

Patients and Methods The study included ≥18 years old patients admitted to the emergency department who were asked to undergo IM injection. Patients were randomly divided into two groups as vapocoolant spray and control group. Demographic data, injection side, and visual analog scale (VAS) of the patients were recorded.

Results Mean VAS values during IM injection were significantly lower in patients treated with vapocoolant spray compared with the control group. The severity of pain during IM injection was lower in the vapocoolant spray group as both moderate pain (VAS > 3 cm) and severe pain (VAS > 5.4 cm) compared with the control group.

Conclusion Vapocoolant spray to be applied before IM injection is effective in reducing pain caused by the injection.

The Effectiveness of the Buzzy Device for Pain Relief in Children During Intravenous Injection: Quasirandomized Study

BACKGROUND

Intravenous injection is the most common medical treatment and the main cause of pain in hospitalized children. If there is no appropriate health care for pain relief, the proportion of moderate and severe pain often exceeds 70%. With nonpharmaceutical-based pain management, Buzzy is recognized as an effective device for rapidly relieving injection pain in hospitalized children. However, Buzzy is not widely used in Asia and very few experimental studies in Asia have addressed the effectiveness of the Buzzy device at treating needle pain in hospitalized children.

OBJECTIVE

The main purpose of this study was to investigate the effectiveness of the Buzzy device for diminishing pain levels among hospitalized children in Taiwan.

METHODS

We applied a quasiexperimental design with random assignment. According to the time of admission, child participants were randomly assigned to treatment and nontreatment groups. The Buzzy device was applied as an intervention in this study. The samples size was 30 per group. The study participants were recruited from the pediatric ward of a medical center in northern Taiwan. The research data were collected longitudinally at three time points: before, during, and after intravenous injection. Three instruments were used for assessment: a demographic information sheet, the Wong-Baker Face Scale (WBFS), and the Faces Legs Activity Cry Consolability (FLACC) scale. The data were analyzed by descriptive analysis, the Mann-Whitney U test, the Wilcoxon signed-rank test, and the χ2 test.

RESULTS

A total of 60 hospitalized children aged 3 to 7 years participated in this study, including 30 participants in the treatment group and 30 participants in the nontreatment group. The average age of children in the treatment and nontreatment groups was 5.04 years and 4.38 years, respectively. Buzzy significantly mitigated pain in children during intravenous injection with a significant difference between the two groups in pain-related response (FLACC) and actual pain (WBFS) (Z=-3.551, P<.001 and Z=-3.880, P<.001, respectively). The children in the treatment group had a significantly more pleasant experience than those in the nontreatment group (Z=-2.387, P=.02). When Buzzy was employed, the children experienced less pain than they did during previous intravenous injections (Z=-3.643, P<.001).

CONCLUSIONS

The intervention of using the Buzzy device was effective in reducing pain levels of intravenous injection among hospitalized children. The specific focus on children in Asia makes a valuable contribution to the literature. For clinical application, the reliable pain relief measure of Buzzy can be used in other Asian children to help health care providers improve noninvasive care among children. For future applications, researchers could integrate Buzzy into therapy-related games and a technology-based app to increase the efficiency of use and provide more data collection functions.

Efficacy of an Innovative Device in Reducing Discomfort during Local Anesthesia Administration in Children: A Clinical Study

Aim and objective

To assess the efficacy of an innovative vibrating device and compare it with the conventional method in reducing discomfort during the administration of local anesthesia.

Materials and methods

Forty children in the age-group of 4–8 years requiring local anesthesia for routine dental procedures were allocated to either a control or experimental group, with 20 children in each group. The preoperative assessment of behavior was carried out using the Frankl Behavior Rating Scale. Both groups received local anesthesia using the intraoral conventional approach. However, in the experimental group, a vibrating device was simultaneously placed over the cheek during local anesthesia administration. The SEM (sounds, eyes, motor) scale was used to assess the level of comfort or pain during the administration of local anesthesia. Data were subjected to statistical analysis and the level of significance was considered at 5%.

Results

The mean SEM score in the control group was 6.65 ± 21.95 which was significantly higher than 3.80 ± 1.15 in the experimental group (p < 0.001).

Conclusion

The vibrating device was useful and effective in reducing pain and discomfort during intraoral local anesthesia administration.

How to cite this article

Subramaniam P, Ghai SK. Efficacy of an Innovative Device in Reducing Discomfort during Local Anesthesia Administration in Children: A Clinical Study. Int J Clin Pediatr Dent 2021;14(3):353–356.

Efficacy of external cold and a vibrating device in reducing pain and anxiety during local anaesthesia

Background and Aim:

To evaluate and compare the efficacy of external cold and a vibrating device in reducing the pain and anxiety amidst children receiving maxillary infiltration anaesthesia over conventional methods.

Method:

A sum of thirty subjects aged between 5 and 10 years who had undergone dental procedures requiring maxillary infiltration were enrolled in the current split-mouth randomised control study. The control intervention constitutes infiltration of 1.8 mL of 2% lignocaine in addition to 1:100,000 adrenaline (Lox, Neon Laboratories Mumbai, India) whereas, the experimental group used external cold and a vibrating device (Buzzy®, MMJ Labs, Atlanta, GA, USA) in annexation to the control protocol. Simultaneous to LA administration, pulse rate was employed as an objective measure and the subjective measure was recorded using RMS Pictorial Scale (RMS-PS) for the child’s discomfort. To document the child’s pain as anticipated by the dentist the revised face, limbs, arms, cry and consolability (FLACC-R) scale was employed.

Result:

Lower pain sensation and anxiety was recorded in the experimental group using Buzzy when compared to control.

Conclusion:

External cold in adjacent with vibrations might be efficient in lowering pain as well as anxiety in children experiencing infiltration dental anaesthesia though further research work is requisite with a larger sample size.

Using Vibrating and Cold Device for Pain Relieves in Children: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

Needle procedures are the most common source of pain, anxiety, and fear among children. A combination of a cooling ice-pack and/or a vibrating motor for pain management in children has been evaluated in trials, but their overall effects await a synthesis of the available evidence.

METHOD

Comprehensive search was conducted using Cochrane, PubMed, EMBASE, PsycINFO, CINAHL and Airiti. We calculated pooled risk ratios (RR), mean difference (MD) and 95% CI using RevMan 5.3. A meta-regression was conducted to investigate the effects of mean age on MD of pain.

RESULTS

A total of 1479 children from 16 publications were included. Compared with the control group, using cold-vibrating device significantly decreased pain level above the age of 2 (MD -3.03, 95% CI: -3.38, -2.68), as well as lower anxiety level among parents (MD -1.3, 95% CI: -1.9, -0.7). Meta-regression demonstrated a significant negative correlation of pain score with age. For children at 8.5 years, cold-vibration reduced the pain score by 0.13 averagely for every increment in year compared with controls (MD -0.13; 95% CI: -0.25, -0.01). No adverse events were reported in included studies.

DISCUSSION

The cold-vibrating device reduced pain levels significantly among children without adverse effects. Variation of factors might contribute to the heterogeneity of our study, such as age, different needle procedures, psychological strategies…etc.

CONCLUSIONS

Cool-vibration treatment reduced pain levels in children who underwent needle procedures and the treatment appears more effective in older children. The device is promising in clinical setting due to its non-invasiveness and ease of usage.

Distraction Using Buzzy or Handheld Computers During Venipuncture

OBJECTIVES

Venipuncture is one of the most frequently performed painful procedures in children. The aim of this study was to investigate the effectiveness of 2 analgesic strategies for venipuncture in children in a specific setting like a blood-drawing center.

METHODS

This was a prospective randomized controlled trial. It was conducted in the blood-drawing center of a tertiary level children's hospital in Italy, between November 2014 and February 2015. Eligible patients were children aged from 4 to 12 years referred to the blood-drawing center for venipuncture. Enrolled children were randomized to be distracted by Buzzy device or by playing with a handheld computer. The procedural pain was measured with the faces pain scale-revised by children aged from 4 to 7 years and with a numerical rating scale by children aged from 8 to 12 years.

RESULTS

Two hundred children with a median age of 8 years were enrolled in the study. The self-reported procedural pain was not statistically different between the Buzzy group and the handheld computer group: median (interquartile range) = 3.0 (1.0-4.8) and 2.0 (1.0-4.8), respectively (P = 0.72). Children reported significant pain in 25% of cases with both distraction strategies. The procedural success rate at the first attempt was not significantly different in the 2 groups.

CONCLUSIONS

Analgesia provided by Buzzy or by a handheld computer was not significantly different in children undergoing venipuncture in a blood-drawing center, with the great proportion of them reporting no or mild pain during procedure.

Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial

Background

This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration.

Methods

This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4–11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05.

Results

Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group.

Conclusion

External vibration using a Buzzy® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.

The Effect of Three Different Methods on Venipuncture Pain and Anxiety in Children: Distraction Cards, Virtual Reality, and Buzzy® (Randomized Controlled Trial)

PURPOSE

The aim of this study was to determine the effect of the distraction cards, virtual reality and Buzzy® methods on venipuncture pain and anxiety in children aged 7-12 years.

DESIGN AND METHODS

This was a randomized controlled trial with parallel groups conducted between November 16, 2017 and August 14, 2018 at the pediatric venipuncture unit of a university hospital in Western Turkey. The sample consisted of 142 children who met the inclusion criteria. The experimental group consisted of 108 children divided into three groups: Distraction Cards (DC; n = 35), Virtual Reality (VR; n = 37), and Buzzy® (n = 36). The control group (n = 34) received no intervention during venipuncture. Data were collected using a descriptive characteristics form, and the Visual Analog Scale (VAS), Wong-Baker FACES, and Children's Fear Scale (CFS). The participants themselves and their parents and the researcher scored venipuncture pain and anxiety levels. The study was approved by the Ethics Committee. Permission was obtained from related institutions. Informed consent was obtained from parents. Verbal consent was obtained from children prior to participation.

RESULTS

Buzzy® group had the lowest mean VAS score (2.2 ± 2.0), followed by the VR (2.7 ± 2.8), DC (3.4 ± 2.4), and control (5.2 ± 2.8) groups (p < 0.05). According to all raters (child, parent, and researcher), the Buzzy® group had the lowest mean Wong Baker FACES score, followed by the VR, DC, and control groups (p < 0.05). According to all raters, the Buzzy® group had the lowest mean CFS score, followed by the VR, DC, and control groups (p < 0.05).

CONCLUSIONS

The DC, VR, and Buzzy® methods were effective in reducing venipuncture pain and anxiety in children.

PRACTICE IMPLICATIONS

Nurses can use the DC, VR, and Buzzy® methods to help reduce venipuncture pain and anxiety in children. The clinical trial registration number is NCT04421430. (https://clinicaltrials.gov/ct2/show/study/NCT04421430).

The effectiveness of vibratory stimulation in reducing pain in children receiving vaccine injection: A randomized controlled trial

BACKGROUND

Although vaccine injections are important, children experience pain and discomfort upon their administration. BUZZY®, a vibratory stimulation tool with an ice pack, was reported to be an effective tool for reducing the pain caused to children during injection administration; its mechanisms were explained by gate control theory. However, the evidence is inadequate because of insufficient methodology in previous reports. Therefore, we aimed to assess whether the application of vibration would significantly reduce children's pain during vaccine injections.

METHODS

A single-blind randomized controlled trial recruiting children aged ≤6 years who were receiving vaccine injections was conducted between August and December 2019. If the children's parents consented to their participation, BUZZY® was attached to the child's arm prior to vaccination. BUZZY® was switched on before injection in the intervention group but not in the control group. The vaccination procedure was recorded, and researchers and parents assessed each child's pain using validated pain scales. Researchers conducted their assessment using video data to ensure blinding. Parents were administered a questionnaire after the children's vaccination. Data were analyzed using the t-test or chi-square test.

RESULTS

We analyzed 118 children (intervention group = 62, control = 56). No between-group difference was observed according to the researchers' assessment (mean score = 6.98 and 7.63, respectively; p = 0.25); however, a significant difference was found based on the parents' assessment (mean score = 7.39 versus 8.46; p = 0.02). Most responses received to open-ended questions were positive comments for this study.

CONCLUSIONS

We revealed that the effect of vibration is not significant in reducing vaccine injection pain among children. Further studies are needed to examine the other components of BUZZY®, which include its cooling effect, and the effect of BUZZY® itself in terms of whether children will undergo vaccination without resistance and have reduced trauma related to vaccination.

Minimising Immunisation Pain of childhood vaccines: The MIP pilot study

AIM

Pain associated with immunisations can result in distress and/or anxiety for children and parents. We assessed the feasibility and acceptability of two novel devices; Coolsense (cold) and Buzzy (vibration ± cooling pads) versus standard care to minimise pain during immunisations. We also evaluated compliance to the devices and parent's perception of the effectiveness of the devices/standard care for minimising pain during immunisation.

DESIGN

Open label, pilot, randomised controlled trial (RCT).

METHODS

Forty children aged 3.5 to 6 years attending an Immunisation Centre at The Royal Children's Hospital in Melbourne, Australia, were randomised (1:1:1:1) into four groups: (i) Coolsense plus standard care; (ii) Buzzy with cold plus standard care; (iii) Buzzy without cold plus standard care; and (iv) Standard care alone (distraction with bubbles).

RESULTS AND ANALYSIS

Recruitment was completed in 12 days. Seventy percent were compliant with Buzzy (±cold), 82% with Coolsense, and 60% with standard care. Buzzy (with cold) was identified as effective by 70% of parents, Coolsense by 64%, Buzzy without cold by 50% and standard care by 60%.

CONCLUSIONS

This pilot study demonstrated feasibility. A larger RCT is needed to provide definitive evidence to inform best practice for minimising immunisation pain in young children.

Effects of applying external cold and vibration to children during vaccination on pain, fear and anxiety

OBJECTIVES

This study aimed to evaluate the effectiveness of the application of external cold and vibration on children experiencing pain, fear and anxiety during vaccination.

DESIGN AND SETTING

This randomized controlled, experimental study was conducted in primary schools selected within the scope of school immunization days by a community health center. The study population consisted of first grade students who were scheduled to receive a booster dose of diphtheria, tetanus, and acellular pertussis, inactivated poliovirus vaccine (DTaP-IPV) vaccine within the scope of the school immunization program of the said community health center and the study sample consisted of 90 students (experimental: 45, control:45).

MAIN OUTCOME MEASURES

In the experimental group, a device that applies external cold and vibration (Buzzy®) was placed on the injection site for 30 s before administration of the vaccine. The device was then placed above the injection site and kept there during the injection. No intervention was made during the injections in children included in the control group. The same nurse administered the injections in the experimental and control groups.

RESULTS

In the current study, it was found that there was a statistically significant difference between the experimental group and the control group in terms of the children's pain, the nurse's pain, the nurse's fear and the children's anxiety (p < 0.05), but no statistically significant difference in terms of the children's fear (p > 0.05).

CONCLUSIONS

It was concluded that applying external cold and vibration during vaccination has an effect on the level of children's pain and anxiety.

Effect of a Vibration System on Pain Reduction during Injection of Dental Anesthesia in Children: A Randomized Clinical Trial

Background

The ‘‘gate control” theory suggests pain can be reduced by simultaneous activation of larger diameter nerve fibers using appropriate coldness, warmth, rubbing, pressure, or vibration. This study investigated the efficacy of a device combining cold and vibration, for needle-related procedural pain in children. Methodology. A total of 51 children aged 5–12 years participated in this randomized controlled clinical trial. Half of the children were in the control group and received maxillary buccal infiltration, by injecting 1.8 ml of 2% lidocaine with 1 : 100,000 adrenaline using topical anesthesia 20% benzocaine gel for 15 seconds, while the other half were in the test group and received the same anesthesia using a commercially available external cold and a vibrating device. A face version of Visual Analogue Scale (VAS) was used as a subjective measure to assess the child's pain experience. The parents were requested to evaluate the child's ability to tolerate pain using a behavioral/observational pain scale. Sound, Eyes, and Motor (SEM) scale and Faces, Legs, Activity, Cry, and Consolability (FLACC) scale were used to record the child's pain as perceived by the external evaluator. T-test or Mann–Whitney U-test was used for scale variables, paired sample T-test or Wilcoxon rank t-test was used for before and after data, and chi-square was used for categorical variable, based on the results of normality test.

Results

The results showed a statistically significant reduction in pain after the injection for the test group compared with control using VAS scale (mean = 6.68 (1.09) and 8.42 (0.50); p=0.001) and FLACC scale (mean = 5.92 (1.05) and 8.16 (0.54); p=0.002), but not when using SEM scale (mean 3.22 (0.42) and 4.24 (2.74);p=0.08).

Conclusions

Combined external cold and vibrating devices can be an effective alternative in reducing experienced pain and fear in children undergoing infiltration dental anesthesia. This study was registered with clinical trial registry of the United States National Institutes of Health (NIH) at ClinicalTrials.gov (NCT03953001).

Efficacy of Buzzy® on pain and anxiety during catheterization in children

BACKGROUND

The use of a peripheral intravenous cannula is a common clinical practice, and it is known to be a major source of pain and anxiety in children. The aim of this study was to examine the effect of the use of the Buzzy^® on pain and anxiety in children during peripheral cannula application.

METHODS

The research sample consisted of 60 children between the ages of 8 and 16. For children in the experimental group, external cold and vibration were applied by means of the Buzzy^® device. Before and during the peripheral intravenous cannula procedure, the levels of fear and anxiety relating to the procedure of the child patients in both the experimental and control groups were assessed by the children themselves and by an independent observer. Immediately after the vein entry procedure had been carried out, the level of pain felt by the children was determined.

RESULTS

The results of the statistical analysis showed no statistically significant difference between the anxiety levels of the groups before and after the procedure (P > 0.05). The results of the statistical analysis also showed no statistically significant difference between the postprocedural mean pain scores of the children as reported by the children themselves and by the observer (P > 0.05).

CONCLUSIONS

In this study, unlike most studies in the literature, the conclusion was reached that the use of the Buzzy^® to reduce pain and anxiety during the application of a peripheral intravenous cannula in children was not effective.

Does practising hypnosis-derived communication techniques by oncology nurses translate into reduced pain and distress in their patients? An exploratory study

Objectives

To explore the effects of a hypnotic communication (HC) training for paediatric nurses in decreasing patients' pain and distress during venipunctures.

Methods

A 4-day theoretical and practical HC training was offered to five paediatric oncology nurses. The effects of HC were tested with 22 young cancer patients (13 girls, 9 boys, 10 ± 4 years) over four time points, with 88 encounters being video-recorded and coded in stable professional-patient dyads. Patients' pain and distress were rated by patients and parents with visual analogue scales and coded from recordings using the Faces, Legs, Activity, Cry and Consolability (FLACC) scale.

Results

We observed a significant decrease in pre-post distress reported by parents (d = 0.45, p = 0.046). Two out of five nurses with higher skills acquisition had larger reduction in patients' self-reported pain (d = 1.03, p = 0.028), parents perceived pain (d = 1.09, p = 0.042), distress (d = 1.05, p = 0.043) as well as observed pain (d = 1.22, p = 0.025). Favourable results on pain and distress did not maintain at follow-up.

Conclusion and clinical implications

Training nurses in HC may translate into improved pain and distress in patients, both self-rated and observed provided that skills are used in practice. HC training is a promising non-pharmacological intervention to address pain in paediatrics.

Do professionals change their communication behaviours following a training in hypnosis-derived communication? A feasibility study in pediatric oncology

OBJECTIVES

The purpose of this study was to test the feasibility of a training in hypnotic communication techniques (HCTech) for pediatric nurses to prevent procedural pain and distress in children during venipunctures. Specifically, this study aimed to (1) assess nurses' mastery of HCTech and (2) nurses' experience regarding the training program.

METHODS

Participants were 6 female pediatric nurses and 33 of their cancer patients. Nurses took part in a 4-day theoretical and practical training in HCTech. Venipuncture procedures were video-recorded and assessed to evaluate nurses' mastery of HCTech using a standardized scale. Pre-training use of HCTech was compared with post-training and follow-up for the entire nurse sample and across nurses with the same patients (109 nurse-patient interactions). After the follow-up, nurses were questioned about their experience in regards to the training and activities (themes and practice).

RESULTS

Results showed medium pre-post changes in hypnotic communication behaviours (pre-post d = 0.74), with changes maintaining at follow-up (pre-follow-up d = 0.97). Interviews transcripts' analyses revealed moderate levels of motivation and satisfaction regarding the training content and format. Nurses suggested to emphasize on the practice of HCTech in a noisy outpatient clinic as well as offer more practical exercises.

CONCLUSION

A 4-day training in hypnotic communication techniques translated into the use of HCTech by nurses practicing in pediatric oncology when comparing the same dyads at baseline, post-training and follow-up. Results support further refinement and suggest nurses could be trained to prevent pain and distress with hypnosis-derived communication strategies.

Effect of Gum Chewing on Pain and Anxiety in Turkish Children During Intravenous Cannulation: A Randomized Controlled Study

PURPOSE

Although gum chewing is a simple intervention that can be used for the management of pain and anxiety in the nursing care of children, few studies have assessed this intervention. This study aimed to investigate the effect of gum chewing on pain and anxiety during intravenous (IV) cannulation in children.

DESIGN AND METHODS

This randomized controlled study assessed 73 children aged 6 to 12 years in the general paediatric unit in a university hospital in the Trachy Region, Turkey from April to September 2017. In the experimental group, children chewed gum during the procedure. The standard care was applied to the control group. Data were collected via the Children's Anxiety Pain Scale and the Data Collection Form.

RESULTS

According to the children's self-report and the nurse's report, the pain level of the experimental group was significantly lower than the control group. Although no significant difference was noted between experimental and control groups' anxiety levels, nurses stated higher anxiety levels than children.

CONCLUSIONS

The IV cannulation procedure causes pain and anxiety in children. Nurses reported the perception of a higher level of anxiety during the procedure than the children actually experienced. Gum chewing might reduce pain during IV cannulation. Nurses should consider using gum chewing as a simple nursing implementation to increase the effects of other pharmacological and non-pharmacological techniques for management of children's procedural pain.

PRACTICE IMPLICATIONS

Nurses who work with the children could use gum chewing as a simple, inexpensive, and pleasurable intervention for the management of pain.

The Effect of External Thermomechanical Stimulation and Distraction on Reducing Pain Experienced by Children During Blood Drawing

This study aimed to investigate the sole and combined effects of external thermomechanical stimulation and distraction in pain relief of children during blood drawing.This is a randomized clinical trial. The sample consisted of 218 children aged 6 to 12 years who were randomly assigned to 4 groups: group 1 received no intervention, group 2 received external thermomechanical stimulation using Buzzy, group 3 received distraction via DistrACTION Cards, and group 4 received a combination of both external thermomechanical stimulation and distraction. Preprocedural anxiety was assessed through observers' observations using the Children's Anxiety and Pain Scale. Children's pain levels were assessed by themselves, observers, and parents, as reported using the Faces Pain Scale-Revised. Preprocedural anxiety did not differ significantly (P > 0.05). When the 3 study groups were compared with the control group, all 3 groups had significantly lower pain levels than the control group (P < 0.001). The lowest pain level was measured in the combined condition (Buzzy and DistrACTION Cards). The mean score of the device group was lower than the distraction group.

Massage therapy for symptom reduction and improved quality of life in children with cancer in palliative care: A pilot study

BACKGROUND

For children with cancer in palliative care, pain and worry are common and frequently under-managed, which negatively impacts quality of life (QOL). Massage therapy (MT) can lead to reduced pain in children with chronic illnesses. Children with cancer have experienced lower anxiety after MT. No studies have examined the effects of MT in pediatric oncology patients receiving palliative care.

OBJECTIVE

Conduct a MT intervention to determine intervention acceptability and initial effects on ratings of pain, worry reduction, and quality of life.

DESIGN

Pre-post single group pilot study.

SETTING/SUBJECTS

Eight children with cancer (age 10-17) and one of their parents were recruited from a palliative care service.

PROCEDURE/MEASUREMENTS

Baseline (one week prior to intervention): demographics, MT expectations, QOL, and pain measures. Intervention (one month): MT was provided once per week, with children's pain and worry ratings occurring immediately before and after each MT session. Follow Up (4-6 weeks after baseline): QOL, pain, and MT/study acceptability questionnaires.

RESULTS

Participants reported significant decreases in pain following two MT sessions, and worry following one session. No significant changes in pain symptoms and QOL were found between baseline and follow up. Participants positively endorsed the study and the MT intervention, and there were no adverse effects reported.

CONCLUSIONS

MT may lead to immediate decreases in pain and worry in children with cancer who are receiving palliative care, however the effects may not be sustained long term. Difficulties regarding protocol feasibility including recruitment and study compliance remain important considerations for future work.

Effects of Vibration and Cold Application on Pain and Anxiety During Intravenous Catheterization

PURPOSE

To determine the effects of vibration and cold gel pack application on pain and anxiety levels of patients undergoing intravenous (IV) catheterization.

DESIGN

A randomized controlled, pretest and post-test experimental study.

METHODS

Catheterization was performed 60 seconds before the IV catheterization procedure was started by applying vibration and cold gel pack to patients in the experimental group. Patients in the control group underwent catheterization using standard procedures.

FINDINGS

The mean pain scores of patients in the experimental group were lower than those of the patients in the control group. Intragroup analysis demonstrated that the mean scores obtained from the state anxiety and trait anxiety inventories after the study were not significantly different from those obtained before the study.

CONCLUSIONS

Vibration and cold gel pack application is suggested to relive pain during IV catheterization in adults.

The Use of the Buzzy, Jet Lidokaine, Bubble-blowing and Aromatherapy for Reducing Pediatric Pain, Stress and Fear Associated with Phlebotomy

PURPOSE

This study aimed to investigate the effects of the Buzzy, Jet lidokaine, bubble-blowing and inhalation aromatherapy with lavender essence on pain, stress and fear in children undergoing phlebotomy.

DESIGNS AND METHODS

This study was a prospective, randomized controlled trial. The sample was comprised of children aged 5 to 10 years requiring blood tests. Children were assigned to five subgroups through randomization performed using a computer program: the Buzzy group (n = 39), Jet lidokaine group (n = 39), bubble-blowing group (n = 39), inhalation aromatherapy with lavender essence group (n = 39) and control group (n = 39). The children's levels of pain were evaluated and reported by the parents, observers and the children, who self-reported using the Oucher Pain Scale. The children's fear levels were assessed using the Children's Fear Scale, and salivary cortisol analysis was conducted to evaluate stress levels.

RESULTS

A significant difference was found between the intervention and control groups in terms of levels of pain during and after phlebotomy in favor of the Buzzy group (p < 0.05). There was a significant difference between the fear scores of the children in the intervention and control groups before phlebotomy (p < 0.05). This difference was found to be caused by the bubble-blowing method. There was a significant difference between intervention and control groups fear levels in favor of the Buzzy group during phlebotomy (p < 0.05).

PRACTICE IMPLICATIONS

It is recommended that the Buzzy and bubble-blowing be used during phlebotomy in children to reduce the severity of their pain.

Comparison of the Effectiveness of Two Different Methods of Decreasing Pain During Phlebotomy in Children: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to examine the effect of the applications of external cold and vibration and blowing soap bubbles during phlebotomy in children aged between 3 and 6 years.

DESIGN

This study is a randomized controlled trial.

METHODS

The sample was obtained using block randomization. Children were divided into three groups: "external cold and vibration group," "blowing soap bubbles group," and "control group." Children, their parents, the nurse, and the researcher rated the children's pain during phlebotomy.

FINDINGS

A statistically significant difference between groups was found on pain scores. Pain scores were lower in the groups of external cold and vibration, and blowing soap bubbles than the control group.

CONCLUSIONS

The methods of external cold and vibration and blowing soap bubbles had a pain relieving effect in children aged between 3 and 6 years during phlebotomy.

External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol

INTRODUCTION

Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department.

METHODS AND ANALYSIS

This study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority.

ETHICS AND DISSEMINATION

This study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT02616419.

Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial

BACKGROUND AND AIM OF THE WORK

procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture.

METHODS

A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to "magic gloves" group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS).

RESULTS

Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System.

CONCLUSION

The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than "magic glove" technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures.

Improving vaccine-related pain, distress or fear in healthy children and adolescents-a systematic search of patient-focused interventions

OBJECTIVE

The WHO recently highlighted the need for research into potential interventions that can be used to mitigate pain during mass vaccinations, in addition to interventions specific for adolescents. The current review examines the literature on potential interventions that can be used during mass vaccination settings in healthy individuals between the ages of 4 and 15 years old.

METHODS

Criteria for inclusion were: 1)participants between the ages of 4-15 years, 2)interventions that were patient-focused, 3)vaccinations in healthy individuals, 4)outcome measures to include self-reported pain, fear or distress.

RESULTS

Twenty-seven articles were identified with a total of 31 interventions. Eleven interventions used injection-site specific interventions, 17 used patient-led interventions and three used a combination of both site-specific and patient-led interventions.

CONCLUSION

Interventions using coolant and vibration together, as well as a combination of site-specific and patient-led interventions, showed the most consistent effects in reducing self-reported pain, fear or distress.

Immunizations under sedation at a paediatric hospital in Melbourne, Australia from 2012-2016

BACKGROUND

Sedation for immunizations is of particular importance in a subset of paediatric patients with anxiety disorders, needle phobia, developmental or behavioural disorders. The Royal Children's Hospital (RCH) Melbourne offers a unique immunization under sedation service for these patients. We aimed to evaluate the number and types of patients using inpatient sedation for immunizations, distraction and sedation techniques used, and outcomes of these procedures.

METHODS

A medical record review was conducted on all patients who had immunization under sedation between January 2012 to December 2016 in the RCH Day Medical Unit (DMU).

RESULTS

A total of 139 children and adolescents had 213 vaccination encounters. More than half of the vaccination encounters involved multiple vaccines. A total of 400 vaccines were administered. One third of patients (32.3%) had multiple DMU admissions for vaccinations. The median age of patients was 13 years. There were only 10 (4.7%) failed attempts at vaccination; all due to patient non-compliance with prescribed sedation. The majority of patients (58.9%) had a diagnosis of needle phobia. Sedation was most commonly adequately achieved with inhaled nitrous oxide (54.7% sole agent). Midazolam was often used as an adjunct therapy (42.8%). Local anaesthetic cream or play therapy, were used in only 5.9% and 3.9% of patients respectively, although this may reflect poor documentation rather than actual practice.

CONCLUSIONS

For a subset of paediatric patients for which standard immunization procedures have failed, distraction techniques and conscious sedation enable immunizations to be given safely and effectively. Future research will develop protocols to streamline immunization procedures under sedation.

Effectiveness of vibratory stimulation on needle-related procedural pain in children: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this systematic review is to identify, evaluate and synthesize evidence on the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and under.The review will address the following question: Is vibratory stimulation effective in reducing needle-related procedural pain in children aged 18 years and under, in comparison with no stimulation for needle-related procedures?

The impact of the difficult vascular access, fear, and anxiety level in children on the success of first-time phlebotomy

PURPOSE:

This study aimed to investigate the success of first-time phlebotomy and the affecting factors in children between 4 and 10 years of age.

METHODS:

This descriptive, comparative, and cross-sectional study was conducted on 155 children who underwent phlebotomy. The Sociodemographic Data Form, the Children's Anxiety Meter-State, the Children's Fear Scale, and the Difficult Intravenous Access score were used to collect the data for the study. The relationship between the success of first-time phlebotomy, mean pre-phlebotomy fear and anxiety score, and Difficult Intravenous Access score were examined. The variables affecting the success of first-time phlebotomy were assessed by regression analysis.

RESULTS:

Phlebotomies failed in 18.1% of children. A statistically significant relationship was found between the success of first-time phlebotomy, Children's Anxiety Meter-State, Children's Fear Scale mean scores assessed by the researchers, and Difficult Intravenous Access score. Factors affecting the success of first-time phlebotomy include difficult vascular access, age, mean Children's Anxiety Meter-State score, mean Difficult Intravenous Access score, and duration of the last phlebotomy performed. These factors explain 42% of the total factors affecting the success of first-time phlebotomy.

CONCLUSION:

Child's fear, anxiety before phlebotomy, and difficult vascular access affects the first-time phlebotomy success.

Effects of Virtual Reality and External Cold and Vibration on Pain in 7- to 12-Year-Old Children During Phlebotomy: A Randomized Controlled Trial

PURPOSE

The aim of this study was to evaluate the effects of the virtual reality (VR) and external cold and vibration methods on pain scores in children aged 7 to 12 years during phlebotomy.

DESIGN

A randomized controlled study.

METHODS

The sample of children (n = 121) was allocated to the groups (group 1, VR; group 2, external cold and vibration; group 3, control) by blocked randomization. Pain scores were assessed after the phlebotomy using self-report, parent's reports, report from the nurse who attempted the phlebotomy, and researchers' report with the Wong-Baker FACES scale.

FINDINGS

Pain scores were determined to be lower in groups 1 and 2. Although there was no difference between the groups 1 and 2, a statistically significant difference was found between groups 1 or 2 and group 3 based on all pain scores.

CONCLUSIONS

Results suggest that VR and external cold and vibration are effective in reducing the pain in 7- to 12-year-old children during phlebotomy. VR can be used safely for the pain management of children who are growing up in the age of technology.