Influencing Vaccinations: A Buzzy Approach to Ease the Discomfort of a Needle Stick—a Prospective,Randomized Controlled Trial

BackgroundThe rate of annual influenza immunization in both the general public and health care workers is less than desirable. Mechanisms to improve compliance with recommendations are needed; prevention of immunization site pain has been suggested as a viable route because fear of pain and needles has been cited as a barrier.AimsThis study aimed to evaluate the impact of thermomechanical stimulation (Buzzy) on postprocedure pain ratings during vaccination in adults.DesignThis was a randomized controlled trial of Buzzy during immunization.SettingsThree hospitals and two community health centers which are part of a large, integrated health system.Participants/SubjectsEmployees presenting to employer-sponsored annual influenza vaccination clinics.MethodsA 10-cm visual analog scale was used to rate preinjection anxiety and expectation of pain as well as postprocedure pain scores; participants also rated their satisfaction with the vaccine injection on a 10-point Likert scale.ResultsIn total, 497 employee volunteers were recruited to participate. Preprocedure anxiety was similar between the experimental and control groups (1.53 vs. 1.48, p = .82), whereas self-reported postprocedure pain scores were significantly lower in the group that received the Buzzy during injection (0.87 vs. 1.12, p = .035). Mean satisfaction scores did not vary between the intervention and control groups (9.11 vs. 9.09, p = .87); however, more participants rated their experience as better than previous vaccination experiences in the Buzzy group than control (62.0% vs. 23.9%, p < .0001).ConclusionsThese results suggest that Buzzy reduced pain experienced by adults undergoing annual influenza vaccination and may improve overall experience. Buzzy can be used in adult patients to reduce pain during immunization and is especially effective in those with high levels of anxiety.     

Using Buzzy,Shotblocker, and Bubble Blowing in a Pediatric Emergency Department to Reduce the Pain and Fear Caused by Intramuscular Injection: A Randomized Controlled Trial

IntroductionProcedural pain in general, and intramuscular (IM) injection pain in particular, is one of the most distressing and painful health care experiences for children. Pharmacologic and nonpharmacologic methods are used as forms of pain control for children undergoing acute painful interventions in emergency departments.MethodsThis study was a prospective, randomized controlled trial. The sample consisted of children aged 5 to 10 years old who required IM injections. Children were placed in 4 subgroups through randomization, using a computer program: the Buzzy (MMJ Labs. Atlanta, GA) group (n = 40), the ShotBlocker (Bionix Development Corporation, Toledo, OH) group (n = 40), the bubble-blowing group (n = 40), and the control group (n = 40). Immediately before and after the injection, the children, their parents, and an observer were asked to evaluate the child’s level of fear. The Oucher scale was also employed by the observers, children, and parents immediately after the procedure to assess the level of pain in the children in each group.ResultsNo statistically significant difference was determined between the control and intervention groups in terms gender, age, previous pain experienced with injection, the parent who was with the child, the parent’s age. A significant difference was found between the intervention and control groups in terms of levels of pain and fear during IM injection. Pain and fear were notably less in the group of children receiving the Buzzy intervention.DiscussionThe Buzzy intervention should be used when children are undergoing IM injections to reduce their levels of pain and fear.     

The effect of manual pressure after subcutaneous injection on pain and comfort levels

BackgroundThe pain experienced after subcutaneous injections can also disturb the comfort of the individual. An individual who experiences pain may refuse treatment by experiencing anxiety for subsequent injections.ObjectiveThis experimental study was conducted to compare the effects of standard injection application and manual pressure application use on injection pain and comfort level of having an subcutaneous injection.MethodsThis study was carried out on a single sample group with pre-post design. The individuals in the sample group constituted both the control and intervention groups of the study. In the sample group, subcutaneous injection was applied to the upper outer side of the right and left arms by the same nurse by applying standard application and manual pressure, and then the pain and comfort levels were determined using the VAS and Comfort Scale.ResultsIt was determined that the mean pain scores of the SC injection application performed by applying manual pressure were statistically significantly lower than the SC injection application using the standard method. Again, it was determined that the mean comfort score of SC injection applied by applying manual pressure was statistically higher (p<0.05).ConclusionIt has been determined that manual pressure application is a more effective method in reducing pain due to subcutaneous injection compared to the standard application. It was determined that as the pain experienced by the individuals due to subcutaneous injection application decreased, their comfort level increased. In line with these results, it is recommended that health professionals, especially nurses, use non-pharmacological methods with proven efficacy more frequently to relieve pain in SC injection, follow the developments in this field and put them into practice.     

A Phase I Study to Assess the Effect of Speed of Injection on Pain,Tolerability, and Pharmacokinetics After High-volume Subcutaneous Administration of Gantenerumab in Healthy Volunteers

PurposeGantenerumab, a fully human anti–amyloid-β IgG1 monoclonal antibody that binds to aggregated forms of amyloid-β, is being investigated as a potential disease-modifying treatment for early (prodromal to mild) Alzheimer disease (AD). Our study compared the pain associated with 5- and 15-s subcutaneous injections of gantenerumab and evaluated the tolerability and pharmacokinetic properties of subcutaneous gantenerumab.MethodsThis randomized, open-label, single-active-dose, placebo-controlled crossover study was conducted in 50 healthy volunteers aged 40–80 years with no history of clinically significant disorders, drug or alcohol abuse, familial history of early-onset AD, or prior gantenerumab exposure. Eligible participants were randomized to a sequence of one 300-mg SC gantenerumab injection into the abdomen and 2 SC placebo injections (1 into the abdomen and 1 into the thigh) during 5 or 15 s. All injections were administered at least 90 min apart. Participants were assessed for local pain by visual analog scale (VAS) and verbal rating scale; safety profiles were assessed by recording adverse events (AEs), and plasma pharmacokinetic properties were also evaluated.FindingsImmediately after the subcutaneous gantenerumab injection, the pain VAS score was numerically higher without reaching statistical significance in the 5-s versus 15-s injection group (VAS least-squares mean difference, 7.492 mm; 95% CI, −4.439–19.423 mm). In both injection speed groups, the mean pain VAS score was comparable after subcutaneous gantenerumab and placebo injections into the abdomen. Pain was reported after needle insertion and immediately after dosing, subsiding within 5 min after the dose. The pain VAS score was numerically higher after SC placebo injection into the thigh versus abdomen (5-s injection group: mean [SD] VAS score, 26.68 [27.83] vs 19.20 [25.60] mm; 15-s injection group: mean [SD] VAS score, 14.16 [20.62] vs 9.48 [12.04] mm). No serious AEs were reported; no participants withdrew because of an AE. All AEs were of mild intensity, were transient, and had resolved without sequelae at follow-up. The most common AEs were injection site reactions; redness was the most frequently observed skin reactivity event after subcutaneous gantenerumab administration (5-s injection group: 36%; 15-s injection group: 32%). After subcutaneous administration, gantenerumab reached a peak plasma concentration at a median time of 119 h (approximately 5 days); plasma concentrations declined in a monoexponential manner. Comparable pharmacokinetic profiles were observed between the injection speed groups.ImplicationsSubcutaneous gantenerumab injections at speeds of 5 and 15 s were well tolerated in healthy volunteers and could enable at-home administration by patients with AD or their caregivers. ClinicalTrials.gov identifier: NCT02882009.     

Effectiveness of nitrous oxide and analgesic cream (lidocaine and prilocaine) for prevention of pain during intramuscular botulinum toxin injections in children

AimsTo evaluate the effectiveness of an analgesic protocol with nitrous oxide and anaesthetic cream (lidocaine and prilocaine, EMLA) for children undergoing botulinum toxin injections.Patients and methodsProspective study including 51 injection sessions, 34 children with a mean age of 5.94 (range 2–15) and 209 injected muscles. Pain was evaluated with the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS), the Visual Analogue Scale (VAS) and the Face Pain Scale (FPS) for the children and with a VAS for the parents.ResultsCHEOPS score for the 51 sessions was 8.50 (S.D. 3.56). Forty-nine percent of scores were above the therapeutic threshold of 9; 25% of the children evaluated the pain above the therapeutic threshold of 3; 44.74% of the parents’ estimations exceeded 3. No correlation was found between age, weight, number of injected muscle and CHEOPS score.ConclusionThe association of MEOPA and anaesthetic cream is only effective for 50% of children. This is much lower than treatments for other types of acute induced pain in children. Botulinum toxin injections and cerebral palsy children present certain specificities which require improvements in this analgesic protocol.     

Ultrasound-Guided Standard vs Dual-Target Subacromial Corticosteroid Injections for Shoulder Impingement Syndrome: A Randomized Controlled Trial

ObjectiveTo compare dual-target injection with standard ultrasound (US)-guided subacromial injection in patients with subacromial impingement syndrome (SIS) and possible disorders of the biceps long-head tendons.DesignDouble-blind, randomized controlled trial.SettingRehabilitation outpatient clinic.ParticipantsPatients with SIS (N=60).Intervention(1) US-guided standard subacromial bursa; (2) dual-target (subacromial bursa plus proximal biceps long-head tendon) injection, with 40-mg triamcinolone acetonide administered to patients in each group.Main Outcome MeasuresClinical assessments were performed at baseline. The outcomes, including results from a self-administered questionnaire, the Shoulder Pain and Disability Index (SPADI), and a self-pain report, the visual analog scale (VAS) scores for pain at rest, at night, and during overhead activities, were evaluated at baseline and at the first and third months postintervention.ResultsNo significant difference was observed in baseline evaluations between groups (n=30 in each treatment arm) prior to injections. Both groups exhibited significant SPADI and VAS-score improvements after the first month. The dual-target injection group had less rebounding pain at the 3-month follow-up. The standard injection group had more patients reporting worsening pain within 1 day postinjection.ConclusionUS-guided dual-target corticosteroid injection showed similar short-term efficacy to standard subacromial injections, but with an extended duration of symptom relief. Therefore, dual-target corticosteroid injections may be useful for shoulder pain treatment in patients with SIS.     

Efficacy of Topical Vibratory Stimulation for Reducing Pain During Trigger Point Injection to the Gastrocnemius: A Randomized Controlled Trial

ObjectiveTo evaluate the efficacy of topical vibratory stimulation for reducing pain during trigger point injection (TPI).DesignDouble-blind randomized placebo-controlled clinical trial.SettingTertiary care university hospital.ParticipantsA total of 136 participants were randomly recruited from among patients with myofascial pain syndrome who were scheduled for TPI. Of these, 65 were excluded because they met the exclusion criteria, and 11 because they refused to participate. Finally, 60 participants were enrolled. No participants dropped out of the study.InterventionParticipants were randomly assigned to the vibration group or control group. TPI was performed with 0.5% lidocaine using a 25-gauge needle. A vibrator was applied to the popliteal fossa for 3 to 5 seconds prior to and during TPI to the gastrocnemius; 100-Hz vibration was turned on for the vibration group and turned off for the control group.Main Outcome MeasuresPain intensity during TPI was assessed using a 100-mm visual analog scale (VAS) as a primary outcome, and participant satisfaction and preference for repeated use were measured using 5-point Likert scales as a secondary outcome. These parameters were evaluated immediately after TPI. The primary outcome was evaluated using analysis of covariance and secondary outcome using the Mann-Whitney U test.ResultsVAS scores for pain during TPI were significantly lower in the vibration group (30.30; 95% confidence interval [CI], 22.65-39.26) compared with the control group (47.58; 95% CI, 38.80-56.52; F=7.74; P< .01). The mean difference in VAS scores between the 2 groups was 17.27 (95% CI, 5.24-29.30). Participant satisfaction and preference for repeated use were significantly higher in the vibration group than in the control group (P<.05). No participant showed any side effects.ConclusionTopical vibratory stimulation significantly decreased pain during TPI of the gastrocnemius.     

Effect of muscle energy technique and static stretching on pain and functional disability in patients with mechanical neck pain: A randomized controlled trial

BackgroundMechanical neck pain is one of the common musculoskeletal disorders. Muscle energy technique (MET) may be a useful intervention for treating such disorder.ObjectiveThe aim of this study was to compare the effect of MET with passive stretching on pain and functional disability in people with mechanical neck pain.MethodsA randomized controlled trial was undertaken. Sixty patients with mechanical neck pain were randomly allocated to either the MET group or control group. The former group received MET, and the latter group received static stretching. Both groups received conventional therapy. Treatment was given once a day for 6 days. A visual analogue scale (VAS) was used to measure the intensity of pain, and functional disability was assessed using the neck disability index (NDI) was immediately before treatment and again on the 6^th day.ResultsVAS and NDI scores showed a significant improvement in both MET and stretching groups on the 6^th day postintervention (p < 0.05). However, both VAS and NDI scores showed better improvement in the MET group as compared to the stretching group (p < 0.025).ConclusionMuscle energy technique was better than stretching technique in improving pain and functional disability in people with mechanical neck pain.     

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

IntroductionDistraction 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.MethodsA 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.ResultsThere 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.DiscussionVirtual 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.     

Effect of Methylprednisolone Injection Speed on the Perception of Intramuscular Injection Pain

Pain originating from intramuscular (IM) injection should not be underestimated, because a painful injection might incite severe fear of injection, which may lead a patient to delay seeking medical help. The aim of this study was to determine the impact of two different IM methylprednisolone injection speeds on pain intensity and pain duration. A one-group quasiexperimental design was used to study 10-second versus 30-second injection durations. According to the formula for one sample using average values, 25 patients were recruited from a dermatology clinic. Data were collected using the “Patient Characteristics Form” and the visual analog scale (VAS). The mean difference in pain levels according to the VAS in the postinjection period was significantly higher with administration of IM methylprednisolone in 10 seconds compared with 30-second administration (VAS 1.9 vs. 1.3; p < .05). The severity of pain peaked at 0 minutes for both injection speeds, but the duration of pain was longer with 10-second injections. The data showed that at multiple time points after 10-second injections, men and patients >40 years old experienced greater pain severity. Pain severity after 30-second injections was greater for patients of normal or low weight who had completed higher levels of education. In conclusion, slow IM injection of steroids improves pain management.     

Massaging as a pain-relieving intervention before performing intravenous access

PurposePain is “an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of damage”. Stimulating the skin by rubbing, stroking, massaging, or applying pressure near the injection site is pain-relieving. Needle-related procedures induce anxiety, distress, and fear in children and adults. The present study aimed to test the effectiveness of massaging the access site in reducing pain associated with intravenous access.DesignAfter obtaining institutional ethics committee approval, this prospective randomized single-blinded study was performed on 250 ASA I-II patients 18 to 65 years old, scheduled for elective minor general surgery under general anaesthesia.MethodsPatients were randomized into the Massaging Group (MG) and the Control Group (CG). A Situational Trait Anxiety Inventory (STAI) was conducted to evaluate the anxiety levels of the patients. In addition, the skin adjacent to the intravenous access site was massaged for 15 s in circular motions with moderate intensity by the investigator's right thumb before performing the intravenous access in the MG. The CG did not receive any massage adjacent to the access site. The primary endpoint, the intensity of perceived pain, was rated on a non-graduated 10-cm Visual Analogue Score (VAS).FindingsThe groups' demographic data and STAI I-II scores were similar. There was a significant difference between the VAS scores of the two groups (p < 0.05).ConclusionsOur results support massaging as an effective pain-relieving technique before intravenous intervention. As massaging is a universal and non-invasive intervention that requires no advanced preparation, we recommend massaging before each intravenous cannulation to reduce pain caused by intravenous access.     

Scrambler Therapy May Relieve Chronic Neuropathic Pain More Effectively Than Guideline-Based Drug Management: Results of a Pilot,Randomized, Controlled Trial

ContextNeuropathic pain is common, disabling, and often difficult to treat.ObjectivesTo compare guideline-based drug management with Scrambler therapy, a patient-specific electrocutaneous nerve stimulation device.MethodsA clinical trial with patients randomized to either guideline-based pharmacological treatment or Scrambler therapy for a cycle of 10 daily sessions was performed. Patients were matched by type of pain including postsurgical neuropathic pain, postherpetic neuralgia, or spinal canal stenosis. Primary outcome was change in visual analogue scale (VAS) pain scores at one month; secondary outcomes included VAS pain scores at two and three months, pain medication use, and allodynia.ResultsFifty-two patients were randomized. The mean VAS pain score before treatment was 8.1 points (control) and 8.0 points (Scrambler). At one month, the mean VAS score was reduced from 8.1 to 5.8 (?28%) in the control group, and from 8 to 0.7 points (?91%) in the Scrambler group (P < 0.0001). At two and three months, the mean pain scores in the control group were 5.7 and 5.9 points, respectively, and 1.4 and 2 points in the Scrambler group, respectively (P < 0.0001). More relapses were seen in polyradicular pain than monoradicular pain, but retreatment and maintenance therapy gave relief. No adverse effects were observed.ConclusionIn this pilot randomized trial, Scrambler therapy appeared to relieve chronic neuropathic pain better than guideline-based drug management.     

Effect of cold application and compression on pain and bruising in subcutaneous heparin injection

Background and AimSubcutaneous administration may result in complications such as bruising and pain at the injection site. This study was performed as in order to determine the effect of cold application and compression on pain and bruising in subcutaneous heparin injection.MethodsThe study was a randomized controlled trial. 72 patients were included in the study. Each patient in the sample was both experimental (cold and compression) and control groups and 3 different parts of abdomen were used for injection of each patient. The data of the research were collected by using Patient Identification Form, Subcutaneous Heparin Observation Form and Visual Analog Scale (VAS).ResultsIn the study, it was observed that after heparin injection, ecchymosis developed in 16.4%, 28.8%, and 54.8% of the patients, respectively, and pain was experienced during injection in 12.3%, 43.5%, and 44.2% of the patients, respectively, on the pressure, cold application, and control site groups, and this difference was statistically significant (p<0.001).ConclusionIn the study, it was found that bruising size of the compression group was smaller in contrast with the other groups. When the VAS mean was examined for the groups, it was found that the patients in the compression group had lower pain than the other groups. In order to prevent complications that may arise in nurses' subcutaneous heparin injections and to increase the quality of patient care, it may be recommended to transfer the 60-second compression application after subcutaneous heparin applications to clinical applications and to conduct studies comparing compression and cold application with other applications for future studies.     

Association Between Type of Face Mask and Visual Analog Scale Scores During Pain Assessment

AimsTo examine the association between the type of mask worn by health care professionals and assessment of pain intensity in patients after orthopedic surgery using the visual analog scale (VAS).DesignA nonrandomized controlled trial conducted among 176 patients hospitalized in an orthopedic department of a hospital located in northern-central Israel from January to March 2021.MethodsIn the intervention group (n = 83), pain assessment using the VAS was performed by a health care professional wearing a transparent face mask, while in the control group (n = 93), pain assessment was performed by a health care professional wearing a standard nontransparent face mask. The initial assessment was performed by a nurse, and 15 minutes later, an additional assessment was performed by a physician.ResultsHealth care professionals wearing a standard non-transparent mask obtained higher VAS scores than health care professionals wearing a transparent mask. In addition, nurses obtained lower VAS scores than physicians. The discrepancy in VAS scores between nurses and physicians was found in 50% of cases. This discrepancy was more prevalent among female patients, patients after knee replacement or spinal surgery, and when health care professionals were wearing a standard nontransparent mask.ConclusionsThis study supports the use of transparent face masks by health care professionals in an orthopedic department, particularly by nurses. In addition, this study supports the assumption of problems involving the reliability of VAS.     

超声引导下关节腔注射联合关节囊扩张治疗冻结肩

目的 观察超声引导下肩关节腔注射联合关节囊扩张治疗冻结肩的价值。方法 将100例临床诊断为冻结肩的患者随机分为试验组和对照组,每组各50例。对试验组进行连续3次超声引导下肩关节腔注射联合关节囊扩张治疗,对照组仅行连续3次单纯超声引导下关节腔注射治疗;分别于治疗前、治疗后6周和12周对肩关节疼痛（VAS）和主动活动范围（AROM）进行评分。结果 治疗后6周及12周,2组VAS及AROM均较治疗前明显改善（P均<0.05）。治疗后6周和12周,2组间VAS评分差异均无统计学意义（P均>0.05）;而试验组AROM评分均明显高于对照组（P<0.05）。结论 超声引导下肩关节腔注射联合关节囊扩张和单纯关节腔注射法均能有效改善冻结肩患者疼痛,而在改善肩关节功能方面,超声引导下肩关节腔注射联合关节囊扩张法的短、中期疗效明显优于单纯注射法。     

Comparison of 3 Needle Sizes for Trigger Point Injection in Myofascial Pain Syndrome of Upper- and Middle-Trapezius Muscle: A Randomized Controlled Trial

Yoon S-H, Rah UW, Sheen SS, Cho KH. Comparison of 3 needle sizes for trigger point injection in myofascial pain syndrome of upper- and middle-trapezius muscle: a randomized controlled trial.

Objectives

To investigate (1) the relation between needle diameter and treatment efficacy of myofascial pain syndrome and (2) the relation between needle diameter and pain intensity during injection.

Design

Randomized controlled trial.

Setting

University-affiliated tertiary-care hospital.

Participants

Volunteers (N=77) with myofascial pain syndrome affecting upper- and middle-trapezius muscles with at least 3 months' duration of pain.

Intervention

Participants were randomly assigned to receive trigger point injections on 1 side of the trapezius with a 21-, 23-, or 25-gauge needle. After a 1-time injection, participants were followed up for 14 days. Participants and the assessor were blinded for group assignment.

Main Outcome Measures

Treatment efficacy was measured with the visual analog scale (VAS; at pretreatment, and posttreatment on days 1, 4, 7, 14) for neck and upper-back pain, the Neck Disability Index (NDI; at pretreatment, and posttreatment on days 7, 14), and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36, at pretreatment and posttreatment on days 7, 14) for health-related quality of life. Pain intensity during injection was evaluated immediately after injection with VAS.

Results

VAS scores for posttreatment on days 4, 7, and 14 decreased significantly compared with pretreatment scores in all groups; NDI scores on days 7 and 14 decreased significantly compared with pretreatment scores in all groups; SF-36 scores on days 7 and 14 decreased significantly compared with pretreatment scores in the 21- and 23-gauge needle groups; and SF-36 score on day 14 showed significant difference between the 21- and 25-gauge needle groups. For pain intensity during injection, VAS scores indicated no significant difference between the 3 groups.

Conclusions

No difference between the needle types was observed in terms of VAS or NDI, or in terms of pain intensity felt by patients during injection. In terms of SF-36 scores, injections with 21- or 23-gauge needles were found to be more effective. However, a well-controlled investigation is needed to explore the effect of needle thickness on health-related quality of life.     

The Effects of Dexamethasone on the Time to Pain Resolution in Dental Periapical Abscess

BackgroundDental infections are frequently encountered in the emergency department (ED), with periapical abscesses being among the most painful. Traditional pain management strategies include local anesthetic injections, oral analgesics, and intravenous opioids.ObjectivesWe sought to identify an alternative pain management strategy with early use of dexamethasone as adjunct to conventional therapies for inflammation and pain at the site of infection.MethodsWe conducted a prospective, randomized, double-blind, placebo-controlled study comparing the analgesic effect of dexamethasone and placebo in ED patients with periapical abscess during a 2-year timeframe at two urban academic EDs. Adult patients presenting with physical examination findings consistent with a diagnosis of periapical abscess were randomized to receive oral dexamethasone or an identical placebo. Pain was assessed using the verbal numeric scale in person at discharge and via telephone at 12, 24, 48, and 72 h after discharge from the ED.ResultsSeventy-three patients were enrolled, with 37 receiving dexamethasone and 36 receiving placebo. Follow-up pain scores were obtained for 52 patients at 12, 24, 48, and 72 h. Ten patients from the dexamethasone group and 11 from placebo group were lost to follow-up. Patients who received dexamethasone reported a greater reduction in pain at 12 h compared with the placebo group (p = 0.029). Changes in pain scores from baseline and at 24, 48, and 72 h were not statistically significant. No adverse events were reported.ConclusionsSingle-dose dexamethasone as adjunct to conventional medical management for pain caused by periapical abscess demonstrated a significant reduction in pain 12 h post treatment compared with placebo.     

The effects of music on anxiety and pain in patients during carotid endarterectomy under regional anesthesia: A randomized controlled trial

ObjectiveMusic can be used as an alternative method to decrease anxiety in awake patients during surgical procedures. The aim of this study was to test the hypothesis that listening to music during carotid endarterectomy (CEA) under regional anesthesia decreases the patient’s anxiety and pain.DesignA multicenter, prospective, randomized controlled trial.SettingPatients undergoing carotid endarterectomy under cervical plexus block.InterventionsPatients scheduled for carotid endarterectomy under cervical plexus block were randomized into two groups: Music Group and Control Group.Main Outcome MeasuresThe primary endpoint of this study was the difference in intraoperative anxiety in patients with or without music during CEA under regional anesthesia, and the secondary endpoints were intraoperative and postoperative pain, use of additional local anesthetics, use of intravenous analgesics, patient and surgeon satisfaction and complications. Anxiety was assessed using State Trait Anxiety Inventory (STAI) and numeric rating scale (NRS). Visual analog scale (VAS) was used for pain assessment.ResultsThe postoperative STAI scores were similar in both groups (p = 0.839). The NRS scores measured immediately after the end of the surgery were statistically higher in Music Group (p = 0.001). The intraoperative anxiety statistically increased in Music Group, when the scores of the intraoperative responses to the questions of “are you relaxed?” and "are you calm?" were compared. (p = 0.0001 and p = 0.0001, respectively). There were no statistical differences in terms of the amount of intraoperative and postoperative analgesic used (p = 0.801, p = 0.773, respectively). The intraoperative VAS scores, postoperative VAS scores, patient and surgeon satisfaction scores were similar in both groups (p = 0.586, p = 0.185, p = 0.302 and p = 0.599, respectively). Systolic, diastolic and mean arterial blood pressure and heart rate were no different between Music Group and Control Group at any of all time points during the intraoperative period. Surgical side and contralateral side cerebral rSO2 values are similar in both groups (p = 0.438, p = 0.397, respectively).ConclusionsMusic use in CEA under regional anesthesia increased intraoperative patient anxiety, and had no effect on intraoperative and postoperative pain or patient satisfaction.     

The Effect on Pain and Anxiety of Hot Pad Applied to Patients During Transrectal Prostate Biopsy

AimThe aim of the study was to evaluate the effect of the application of a heating pad on the sacral region on pain and anxiety during a transrectal prostate biopsy.DesignThis was a quasi-experimental study.MethodsThe quasi-experimental study was conducted in the Urology Outpatient Clinic of a Training and Research Hospital in Istanbul. A total of 40 males were nonrandomly divided into two groups: experimental group (n = 20) and control group (n = 20). A heating pad (40-45°C) was applied to the sacral region of the patients in the experimental group during transrectal prostate biopsy. Data were collected using the Beck Anxiety Inventory (BAI) and visual analogue scale (VAS).ResultsIt was detected that the mean scores of the BAI were significantly lower in the experimental group compared with the control group (p < .001). The scores of the VAS were significantly lower in the experimental group compared with the control (p = .016).ConclusionApplying a heating pad to the sacral region during a transrectal prostate biopsy is an effective non-pharmacologic method to increase patient comfort and reduce pain and anxiety.     

Effect of Transcutaneous Electrical Nerve Stimulation on Postoperative Pain and Patient Satisfaction

Background and AimsThis study was conducted to investigate the effect of transcutaneous electrical nerve stimulation on postoperative pain, changes in patients’ vital signs, and patient satisfaction after inguinal herniorrhaphy.DesignThis study used a randomized controlled design.SettingA state hospital in the west of Turkey.Participants/SubjectsThe study was conducted on 52 patients who had inguinal herniorrhaphy between January and July 2015.MethodsPatients were randomly divided into two groups (intervention and control). Intervention group patients received transcutaneous electrical nerve stimulation postoperatively five times for 30 minutes each. Electrodes in control group patients were placed, but the device was not started. At each transcutaneous electrical nerve stimulation session, the patients’ vital signs and pain severity were recorded. A satisfaction scale was administered before discharge to assess patient satisfaction with nursing care.ResultsPain scores of patients in the intervention group were lower than those in the control group (p < .05). No differences were found in pre–and post–transcutaneous electrical nerve stimulation in the vital signs. Satisfaction scores were higher in the intervention group than control group (p < .05).ConclusionsAfter inguinal herniorrhaphy, transcutaneous electrical nerve stimulation reduced postoperative pain without a negative impact on vital signs and increased patient satisfaction with nursing care.