Vaccination Related Pain: Comparison of Two Injection Techniques.

Abstract

To compare the acute pain response during immunization in infants using a slow "standard" injection technique vs. "pragmatic" technique. In this randomised controlled trial, source of data were 200 healthy infants of age group 6 wk to one and half years, receiving routine intramuscular vaccination. They were divided randomly using computer generated random numbers into 'Standard group' receiving immunization using standard slow technique with aspiration and 'Pragmatic group' receiving immunization using "pragmatic" technique without aspiration. The entire vaccination procedure was videotaped. Videos were scored for pain using modified behavioral pain scale (MBPS) by 2 clinical psychologists and the mean score was considered for analysis. Pain was scored within 15s of the immunization, were measured and described the child's maximal pain response to the injection. Cry time was measured by a different person from the start of cry till it ends. Entire data was entered in a preformed proforma. The Z test for two sample population means was used for statistical analysis. Standard technique of vaccination needs longer time to administer (5-10s) when compared to pragmatic technique (1-2s). Mean post vaccination MBPS in standard group was 8.4 (SD - 0.75) and in pragmatic group was 7.8 (SD - 1.17) which was statistically significant (p - 0.00). Mean crying duration in pragmatic group was less (32.1s) than standard group (37.37s). The "standard" slow technique was significantly more painful and took longer to administer than the "pragmatic" rapid technique. Cry duration is lesser in pragmaticgroup than standard group, but it is statistically not significant.