Evaluating the Effect of Valsalva Maneuver on Pain Occurring During Knee Injection

Abstract

Background: Intra-articular injection of steroid is a common treatment for osteoarthritis of the knee and injection is a simple and reliable method However many people refuse it because of fear of needle and injection pain. Baroreceptor activation induces antinociception and the use of Valsalva maneuver for its activation may help to decrease local injection pain. Aim: This study was the first to evaluate the efficacy of Valsalva maneuver on needle insertion pain during local knee injection. Design: prospective randomized trial. Setting: study carried out on patients attending the outpatient clinic of rheumatology and rehabilitation department of Al-Azhar university hospital. Population: patients with osteoarthritis and indicated for local knee injection. Methods: Patients were randomized into 2 groups of 50 each. i. Group I: 50 patients with Knee Osteoarthritis were asked to do Valsalva maneuver during injection. The Valsalva maneuver is performed by having the subject conduct a maximal, forced expiration against a closed glottis and holding this for at least 16 seconds. ii. Group II: 50 patients with Knee Osteoarthritis were given a rubber ball in the palm of the hand and were asked to press it as hard as they could before local injection. All patients were subjected to: Complete history and clinical examination. Patient Pain scoring: pain during injection was evaluated using visual analogue scale (VAS) Physician pain scoring: Pain was graded using a 4-point scale: 0 _ no pain, 1 _ mild pain 2 _ moderate pain 3_ severe pain. Local corticosteroid injection: of 40 mg of triamcinolone acetonide. Results: The results of Pain score in group I was : 33 (66%) patients shows mild pain, 15 (30%) patients shows moderate pain and only 2 (4%) patients shows sever pain. In group II: 0% patient’s shows mild pain, 23 (46%) patient’s shows moderate pain and 27 (54%) patients’ shows sever pain. Figure (1) VAS for pain was 3.7+2.1 in group I and 6.5+1.8 in group II. VAS for pain was significantly lower in group I than group II as p was >0.001. Conclusion: In conclusion we suggest that Valsalva maneuver can decrease the skin puncture pain associated with local knee injection.