Efficacy of the Buzzy® device for pain management of children during needle-related procedures: a systematic review protocol

Effectiveness of External Precooling and Vibration Induced by BUZZY on Pain and Anxiety During Inferior Alveolar Nerve Block Injection in Children

Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self-control, randomized, and double-blind clinical trial evaluated 30 children aged 6-12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong-Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong-Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p=0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection.

Effect of vibratory device on the time of administration of vaccines and on patient satisfaction measures

Previous studies have demonstrated that Buzzy® is effective for pain reduction during vaccination. This study aimed to determine if Buzzy® would have an effect on either duration of vaccine administration and/or patient satisfaction. Pediatric patients aged birth to 18 years old receiving a vaccination were randomized to either a control group receiving no intervention, or the experimental group, utilizing Buzzy®. Time of administration was measured by the number of seconds required by nursing to administer vaccines. Patient satisfaction was measured with a survey given to guardians. Time required was reduced by almost 2 min when utilizing Buzzy®, with median time dropping to 190, 95% CI [26.99, 415.92] seconds from 333, 95% CI [51.35, 627.21] seconds. Patient satisfaction surveys showed positive impacts of using the device, with 100% that used the device reporting that it "made a difference in the pain level experienced," but did not demonstrate statistical significance. This study shows that use of Buzzy® increases efficiency of appointments with possible positive effect on patient satisfaction.

The effect of buzzy®, DistrACTION® cards on reducing pediatric pain and fear during blood collection in the rheumatology polyclinic: A randomized controlled trial

PURPOSE

The aim of this study was to compare the effectiveness of Buzzy® and DistrACTION® Cards in reducing children's pain and fear while taking venous blood samples.

METHODS

This research was designed as a randomized controlled experimental study. The study population consisted of children aged 6-12 years admitted to the Pediatric Rheumatology Diseases Polyclinic in a Faculty of Medicine in Germany. The sample of the study consisted of 96 children (Buzzy® = 32, DistrACTION® Cards = 32, control = 32) who met the patient selection criteria and agreed to participate in the study. The data were obtained using a Child and Family Information Form, the Children Fear Scale (CFS), and the Faces Pain Scale-Revised (FPS-R). The data were evaluated using the Pearson chi-square test, Kruskal-Wallis test, One-way ANOVA test with Bonferroni correction, and Fisher-Freeman-Halton.

FINDINGS

In the study, the average age of the children was 9.21 ± 2.15 years. The Buzzy® group had the lowest pain and procedural fear scores (self-report = 0.88 ± 1.13, 0.31 ± 0.47; parent report = 0.75 ± 0.98, 0.34 ± 0.48, and researcher report = 0.81 ± 1.00, 0.31 ± 0.54, respectively) than the DC, and control groups.

CONCLUSIONS

The Buzzy® method was effective in reducing venipuncture pain and fear in children.

PRACTICE IMPLICATIONS

Nurses can use the Buzzy® methods to help reduce venipuncture pain and fear in children. The clinical trial registration number is NCT05560074. (https://clinicaltrials.gov/ct2/show/study/NCT05560074).

Is the equimolar mixture of oxygen and nitrous oxide (EMONO) associated with audiovisuals effective in reducing pain and side effects during peripheral venous access placement in children? Protocol for a single-centre randomised controlled trial from Italy

INTRODUCTION

Nurses frequently place a peripheral venous catheter during children's hospitalisation. Many studies suggest treatment of venipuncture-related pain. The administration of an equimolar mixture of oxygen and nitrous oxide (EMONO) is employed for pain control; however, no studies have analysed the association between EMONO and audiovisuals.The purpose of the study is to evaluate the effect of EMONO administration when combined with audiovisuals (EMONO+Audiovisual) versus EMONO alone on perceived pain, side effects and level of cooperation during peripheral venous access placement in children aged 2-5 years.

METHODS AND ANALYSIS

The first 120 eligible children admitted to the paediatric ward of the Lodi Hospital and presenting the indication for peripheral venous access will be enrolled. Sixty children will be randomly assigned to the experimental group (EMONO+Audiovisual) and 60 to the control group (EMONO alone).The Face, Legs, Activity, Cry, Consolability scale will be used to assess pain in the children aged 2-years old; pain in the children aged 3-5 years will be assessed using the Wong-Baker scale. The cooperation throughout the procedure will be measured using the Groningen Distress Rating Scale.

ETHICS AND DISSEMINATION

The Milan Area 1 Ethics Committee approved the study protocol (Experiment Registry No. 2020/ST/295). The trial results will be presented at conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05435118.

Multimodal mechanical stimulation reduces acute and chronic low back pain: Pilot data from a HEAL phase 1 study

Background

Effective non-opioid pain management is of great clinical importance. The objective of this pilot study was to evaluate the effectiveness of multimodal mechanical stimulation therapy on low back pain.

Methods

11 female and 9 male patients aged 22-74 years (Mean 41.9 years, SD 11.04) receiving physical rehabilitation for acute (12) or chronic (8) low back pain chose heat (9) or ice (11) to accompany a 20-minute session of mechanical stimulation (M-Stim) therapy (Registered with Clinicaltrials.gov NCT04494841.) The M-Stim was delivered in 12 possible repeating "therapy cycle" patterns by three vibration motors (50 Hz, 100 Hz, 200 Hz) with amplitudes between 0.1-0.3 m/s2. Ten patients used a contained motor chassis attached to a thermoconductive single-curve metal plate. The next 10 patients' device had motors attached directly to a multidimensionally curved plate.

Results

Mean pain on a 10 cm Visual Analog Scale (VAS) with the first motor/plate configuration went from 4.9 ± 2.3 cm to 2.5 ± 2.1 cm (57% decrease, p = 0.0112), while the second reduced pain from 4.8 ± 2.0 cm to 3.2 ± 1.9 cm (45%, p = 0.0353). Initial pain was greater with acute injury (5.8 ± 2.0 cm vs. 3.98 ± 1.8, p = 0.025) and for patients older than 40 (5.44 vs. 4.52), but pain reduction was proportional for chronic and younger patients. There was no significant difference between plate configurations.

Conclusions

A Phase I clinical pilot investigation on a multi-motor multi-modal device was promising for drug free pain relief. Results suggested pain relief independent of thermal modality, patient age, or pain chronicity. Future research should investigate pain reduction over time for acute and chronic pain.

Clinical Trial Registration

https://ClinicalTrials.gov, identifier: NCT04494841.

The Effect of External Cold and Vibration on Infiltration-Induced Pain in Children: A Randomized Clinical Trial

Introduction. Children’s fear of and anxiety about dental treatments are important problems in maintaining health. The anesthetic injection is the main cause of dental fear. One of the methods to reduce the infiltration-induced pain is to use external cold or vibration using the gate control system. Various devices have been used to apply cold and vibration, including the BUZZY device (BUZZY Company, Arizona). Studies have shown contradictory results for the effectiveness of cold and vibration. This study aimed to investigate the effect of cold and vibration versus cold alone on maxillary infiltration-induced pain and stress. Methods. Thirty children aged 6–12 years who required profound restoration of deciduous or permanent first molars were recruited in this randomized double-blind clinical trial. The anesthetic gel and BUZZY device were used in half of the children’s jaws, and the anesthetic gel and the cold alone were used in the other half of the jaws. To measure stress from the heart rate, the Wong–Baker scale was used as the subjective scale, and the face, legs, activity, cry, consolability (FLACC) scale was used as the objective scale. Results. The FLACC score was significantly lower in the BUZZY group than in the cold-alone group, but the Wong–Baker scale and heart rate did not show a significant difference between the two groups. Conclusions. The BUZZY device can be effective in reducing infiltration-induced dental pain.

Comparison of cold spray and shotblocker to reduce intramuscular injection pain: A randomized controlled trial

WHAT IS KNOWN AND OBJECTIVE

It is important to identify effective, easy-to-use and cost-effective non-pharmacological methods in the management of pain caused by medical interventions. The purpose of this study is to compare the effects of cold spray and ShotBlocker on pain in adults in reducing pain caused by intramuscular injection in the adult emergency department.

METHODS

This is a randomized controlled trial with two experimental groups, two placebo groups and a control group. The study was conducted on 195 adults who received diclofenac sodium injections. In the study, the injection procedure was performed by following the same injection protocol in all five groups. In the injection process, cold spray or ShotBlocker was used in the intervention groups based on the group, and cold spray with distilled water or the smooth surface of the ShotBlocker was used in the placebo groups. Following the injection, the pain caused by the injection was evaluated using the Visual Analog Scale.

RESULTS AND DISCUSSION

The study was completed with the remaining 195 patients. In the study, the average pain scores due to injection of the individuals in the cold spray group were lower than those of the control group (p < 0.05). There was no statistically significant difference between the pain score averages due to injection of the individuals in the ShotBlocker group and cold spray, control, ShotBlocker placebo and cold spray placebo groups.

WHAT IS NEW AND CONCLUSION

The routine use of a fast-acting, cost-effective and easy-to-use method, cold spray, to reduce pain in the intramuscular injection will be beneficial in increasing patient satisfaction and quality of care.

Vibration anesthesia during carboxytherapy for cellulite: a study protocol

Background: To date, there has been no investigation addressing the effects of vibration anesthesia during carboxytherapy. Aim: Investigate the analgesic effect of different vibratory devices during carboxytherapy for the treatment of cellulite. Materials & methods: A total of 78 women between 18 and 49 years of age with cellulite in the gluteal region will be randomly allocated to three groups: Group A (carboxytherapy and vibratory device A), Group B (carboxytherapy and vibratory device B) and control group. Pain intensity will be assessed using a numerical rating scale after each puncture. Expected outcome: Vibration anesthesia is expected to be effective at diminishing the pain intensity caused by carboxytherapy comparison with the control group, with no differences between the vibratory devices. Trial registry: Brazilian Registry of Clinical Trials- ReBEC (RBR-8jcqy7c).

Predictive Factors for Anxiety during Blood Sampling and Insertion of Peripheral Intravenous Catheters in Paediatric Patients in Spain

INTRODUCTION

Invasive procedures for diagnosis purposes such as venepuncture and peripheral venous catheter insertion are painful procedures that cause great stress for paediatric patients. The objective of this study is to find out the factors that have an impact on the level of anxiety experienced by children undertaken these procedures.

DESIGN AND METHODS

Prospective study, 359 children between 2 and 15 years old were included, treated in a tertiary reference hospital in the region of Navarra (Spain). The impact of the variables recorded was analysed using a regressive analysis, the Wong-Baker and FLACC scales were used to measure the level of pain and the PACBIS scale to measure the level of stress and anxiety.

RESULTS

The average age of the participants was 7.93 years (SD: 4.04), with 51.8% (n = 186) boys and 48.2% (n = 173) girls. The mean value of pain recorded was 4.43 (SD:3.10). 45.7% (n = 123) of the venepuncture techniques was associated with minimum level of anxiety, including 11.1% of intravenous catheterization. Variables determining the anxiety has been detected such as age, sex, level of pain, parental conduct and time spent on the procedure.

CONCLUSIONS

Paediatric patients experience high levels of anxiety when undergoing painful procedures which are conditioned by multifactorial reasons. The increase in stress is directly related to the older age (>6 years old) of the patient, and statistically significant by the female gender, the longer duration of the technique and the parental block.

PRACTICE IMPLICATIONS

Healthcare professionals should work on some of the variables and apply measures aimed to mitigate anxiety levels. For example, reducing the duration of the procedure, training parents, and distracting techniques.

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.

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).

Effect of external cold and thermomechanical stimulation on anxiety and pain during intravenous cannulation among children

Pain and anxiety are the most common and prevalent adverse stimuli experienced by hospitalised children. The most frightening and distressing source of pain and anxiety accounted for is due to venipuncture. This study aimed to assess the effect of cold and thermomechanical stimulation on pain and anxiety during intravenous (IV) cannulation among children. We conducted a prospective parallel-group randomised control trial in children who required IV cannulation. In the intervention group, external cold and thermomechanical stimulation was applied before 60 seconds, above 5 cm over IV cannulation site through Buzzy device, while the control group received routine care. Children's level of anxiety and pain was assessed using the Children's Fear Scale (CFS) and Wong-Baker Faces pain Scale (WBFS). Mean scores of the self-reported procedural level of pain were less in the intervention group as compared to the control group (2.80 ± 1.86, 7.47 ± 2.40). Median of procedural pain level showed a significant difference between the intervention and control group at p < 0.001, inferring that the Buzzy device strongly resulted in a reduction of perception of pain during the cannulation procedure. However, no significant difference was observed in the median of the procedural level of anxiety between the two groups (p = 0.208), stating that cold and thermomechanical stimulation did not affect the level of anxiety of children. Nevertheless, the combination of cold and thermomechanical stimulation through the Buzzy device did not have a significant impact on the procedural level of anxiety among children. Still, it could optimally alleviate the level of pain.

EMDR and Nonpharmacological Techniques for Anxiety Prevention in Children Prior to Invasive Medical Procedures: A Randomized Controlled Trial

Nonpharmacological Techniques (NPT) have been suggested as an efficient and safe means to reduce pain and anxiety in invasive medical procedures. Due to the anxious and potentially traumatic nature of these procedures, we decided to integrate an eye movement desensitization and reprocessing (EMDR) session in the preprocedure NPT. The main purpose of this study was to evaluate the efficacy of one session of EMDR in addition to the routine NPT. Forty-nine pediatric patients (Male = 25; Female = 24) aged 8–18 years (M = 13.17; SD = 2.98) undergoing painful and invasive medical procedures were randomized to receive standard preprocedural care (N = 25) or a session of EMDR in addition to the standard nonpharmacological interventions (N = 24). Participants completed the anxiety and depression scales from the Italian Psychiatric Self-evaluation Scale for Children and Adolescents (SAFA) and rated anxiety on a 0–10 numeric rating scale. Participants in the NPT+EMDR condition expressed significantly less anxiety before the medical procedure than those in the NPT group (p = .038). The integration of EMDR with NPT was demonstrated to be an effective anxiety prevention technique for pediatric sedo-analgesia. These results are the first data on the efficacy of EMDR as a technique to prevent anxiety in pediatric sedo-analgesia. There are important long-term clinical implications because this therapy allows an intervention on situations at risk of future morbidity and the prevention of severe disorders.