The Impact of Local Pressure on Needle Puncture Pain Severity During Spinal Anesthesia in Patients with Elective Surgery Under Spinal Anesthesia: A Randomized, Single-Blinded, Controlled Clinical Trial

Abstract

Background: Spinal anesthesia is one of the most common and safest methods of anesthesia. However, a challenge for patients who are candidates for spinal anesthesia is the pain caused by inserting the spinal needle. It seems possible to reduce needle pain with local pressure, based on the gate control theory in spinal anesthesia. Objectives: This clinical trial aims to evaluate the effect of applying local pressure on the intensity of pain caused by needles during spinal anesthesia. Methods: In this study, 120 adult patients aged 18 - 50 who were scheduled for elective surgery under spinal anesthesia and had an American Society of Anesthesiologists (ASA) I-III were randomly assigned to the control and intervention groups. In the intervention group, just before inserting the spinal needle, a local pressure of about 5 kg using the thumb was applied to the skin at the needle insertion point for 15 seconds. The control group received routine anesthesia. The severity of needle pain was compared between the two groups using the verbal rating scale (VRS) tool. Results: The incidence of mild pain in the intervention and control groups was 78.7% and 60%, respectively. Also, the control group experienced higher levels of moderate and severe pain compared to the intervention group. In addition, patients in the control group had a higher chance (odds ratio (OR): 3.4, 95% confidence interval (CI): 1.5 - 7.8, P = 0.039) of experiencing moderate to severe pain compared to the intervention group. Pain intensity was significantly lower in patients with a spinal anesthesia history (P = 0.028). Conclusions: Our findings showed that applying local pressure on the skin before inserting a spinal needle can effectively reduce pain during spinal anesthesia. However, further studies with a larger sample size are necessary to confirm the effects of applying local pressure to reduce needle pain during spinal anesthesia.