Procedural Pain Management Research Articles

Comparative Efficacy of Lidocaine, Benzocaine, and Combination Topical Therapy for Pain Reduction in Pediatric Local Anesthesia: A Randomized Clinical Trial Study

Background and objective: Topical anesthetics are highly used in the field of pediatric dentistry such as (Lidocaine and Benzocaine) which are used to relieve pain during needle insertion. The aim of this study to compare and evaluate the effectiveness of multiple topical anesthetic agents prior to anesthetic delivery undergoing pediatric and minor oral procedures. Material and Methods: This study included 60 children of 6-12 years of age, the total number of the samples were divided into 3 groups; Group I: 20 cases (lidocaine gel 20%), Group II: 20 cases (benzocaine gel 20%), and Group III: 20 cases both lidocaine gel 20% and benzocaine gel 20%) were applied before needle insertion during inferior alveolar nerve block and infiltration. In addition, the child's pain assessment was done using the Visual Analog Scale (VAS). Results: 33 boys (55%) and 27 girls (45%) of 6-12 years old participated in the study, the two-step application of both (20% Benzocaine and 20% Lidocaine) showed lower mean scores when it was compared with Benzocaine and Lidocaine, but the results were statistically insignificant. Lidocaine and Benzocaine alone or together are equivalent in efficiency when used as a topical anesthetic agent. The results showed that females and males have no difference in Visual Analogue Scale scores, and with increasing age the VAS score decreased. Conclusion: This study concluded the two-step application of both (20% Benzocaine and 20% Lidocaine) is more effective in reducing pain upon needle penetration into the oral mucosa than each agent used alone, and 20% benzocaine demonstrated better results than 20% lidocaine in reducing pain upon needle penetration. But it was statistically non-significant. The findings highlight the potential benefit of combining topical anesthetics for improved pain management in pediatric dental procedures. Keywords: Needle insertion pain, Pediatric patients, Visual analog scale, Topical anesthesia, Inferior alveolar nerve block.

Pain Management Practice Plan for Neonatal Pain.

Pain Management Practice Plan for Neonatal Pain.

Effectiveness of Neostigmine versus Dexamethasone as an Adjuvant to Bupivacaine for Caudal Epidural Analgesia Among Pediatrics Surgical Patients at Hospitals in Sodo Town: Cohort Study Design

Caudal epidural analgesia is one of the most commonly used analgesia techniques in pediatrics patients. The use of local anesthetics alone has short duration of action in caudal block. So adjuvants are usually added to prolong the duration of local anesthetics with minimum side effects. Neostigmine and dexamethasone are among commonly used adjuvants for caudal block. Objective: This study aimed to assess effectiveness of neostigmine and dexamethasone with Bupivacaine on post caudal block analgesia. Methods: A prospective cohort study design was employed. A consecutive sampling technique was used to select study participants. Data were collected from February 29, 2020 to May 30, 2020. Prior power analysis (G power version 3.1.9.4) statistical software was used to calculate the sample size. The data were entered into Epi info version 7 and transported to SPSS version 26 for analysis. For normally distributed data, an independent t-test was used to compare the mean between the groups. Skewed data were analyzed by the Mann-Whitney test. The difference in mean values was determined by considering a p-value less than 0.05 as a significant difference. Results: The average duration of analgesia in the Dexamethasone Bupivacaine Group (DBG) was 808.00 ± 148.674 minutes, whereas in the Neostigmine Bupivacaine Group (NBG), it was 716.58 ± 116.503 minutes (p=0.002). Notably, the mean cost expense was higher in NBG (160.29 ± 37.360) compared to DBG (139.87 ± 34.439), with a p-value of 0.008. Additionally, the incidence of postoperative Pediatric Opioid-Induced (PONY) was observed to be higher in NBG compared to DBG. These findings suggest that the incorporation of dexamethasone into bupivacaine proved more effective than neostigmine bupivacaine for caudal epidural analgesia in pediatric surgical patients. Conclusion: Our study concluded that the incorporation of dexamethasone with bupivacaine in caudal epidural analgesia for pediatric surgical patients offers superior pain relief compared to neostigmine bupivacaine. These findings suggest that dexamethasone bupivacaine may be a more effective and cost-efficient option for pain management in pediatric surgical procedures, emphasizing the need for further consideration and implementation in clinical practice.

Procedural Pain Management in Patients with Cerebral Palsy Undergoing Botulinum Toxin Injection: A Systematic Review and Meta-Analysis

Background: The aim of this systematic review is to investigate effectiveness and safety of sedation–analgesia techniques in controlling pain during botulinum injections in patients with cerebral palsy (CP). Methods: The Pubmed, Cinahl, and Scopus databases were searched. Inclusion criteria were as follows: cerebral palsy; any type of outcome measure regarding pain and side effects assessment; any type of studies; and English language. RoB2 and Robins-I were applied to assess the risk of bias. Tables and forest plots synthetized the findings. Results: Seventeen reports were included; most regarded pain control, and ten investigated side effects. Three were RCTs, three were controlled, and twelve were observational studies. Several techniques were used, often in combination, such as non-pharmacological approaches (clown care or virtual reality); topical anesthesia with Emla®®, vapocoolant spray, or ice; and light-to-deep sedation with inhaled nitrous oxide, intranasal fentanyl, rectal, enteral, or intravenous midazolam, or intravenous ketamine or propofol. Vomiting and oxygen desaturation were uncommon complications. Conversely, the pooled incidence of other minor side effects was 6.39% (95% CI: 1.47–14.42%) under the random-effects model, with considerable heterogeneity. Conclusions: All the techniques are safe, if administered in an appropriate setting. Deep sedation is more effective in pain control but requires an anesthetist. A combined individualized approach is preferrable. PROSPERO CRD42025639999.

Postoperative pain management quality improvement project using Six-Sigma methodology in Alexandria University Students Hospital, Egypt

Purpose This study aims to assess the effect of the implementation of the Six Sigma approach to improve the quality of post-operative pain management in patients attending Alexandria University Student Hospital. Design/methodology/approach A pre-post interventional study involving patients over the age of 16 years old who were proposed and planned for any surgical operation at Alexandria University Student Hospital. We used Six Sigma’s define, measure, analyze, improve and control (DMAIC) improvement process. Data were gathered from samples evaluated six months before the Six Sigma project’s implementation and seven months after the project’s implementation. The areas selected for improvement were using postoperative pain assessment and reducing postoperative pain management POPM defects. Findings There was a significant decrease in the overall mean (SD) of the worst pain score between the pre-intervention 7.5 (±2.4) and post-intervention 2.7 (±1.9) phases (p < 0.001). A significant decrease (p < 0.001) in the DPMO between pre-and post-intervention phases (580773.4, 78678.2 respectively). That decrease was followed by an improvement in the sigma level of the POPM process (from 1.375 to 3 sigma level). Practical implications This research underscores the efficacy of ongoing quality improvement initiatives, particularly through the Six Sigma DMAIC methodology, in enhancing surgical care by optimizing postoperative pain management. Implementing Six Sigma can significantly increase patient satisfaction by reducing discomfort and improve recovery outcomes by minimizing complications like blood clots, infections and chronic pain. Additionally, it promotes optimal resource utilization and cost efficiency in health-care systems by streamlining pain management procedures. Overall, the study confirms that Six Sigma effectively improves postoperative outcomes and reduces process defects in pain management. However, the research contains a few pitfalls which may be the exclusion of cancer patients, children under 16 years old and intensive care patients. These excluded groups might have different pain management needs and responses and different pain assessment tools, so the results may not apply to these populations. Besides, the research considered mainly general surgery and orthopedic operations for improvement. As they were the most prevalent types of surgeries in the research setting. Originality/value Health-care organizations can improve postoperative pain treatment by implementing the Six Sigma strategy, which incorporates technical integration, patient-centric measurements, customized programs and ongoing improvement. To the best of our knowledge, this is the first study in Egypt and worldwide to investigate the implementation of the Six Sigma strategy in post-operative pain management.

Inequitable management of procedural pain in children: reduction of ileocolic intussusception as an example.

Inequitable management of procedural pain in children: reduction of ileocolic intussusception as an example.

The Role of IR in Pediatric Pain and Palliation

Abstract Pediatric chronic pain is a significant problem that is often underreported and therefore not always adequately addressed. Causes include anatomic variants, trauma, local inflammation, and malignancy. Nerve blocks and cryoneurolysis can aid as an adjunct to pain management for these patients and significantly improve their quality of life. This article will describe specific procedures in which interventional radiology can aid in several specific procedures for pediatric pain management: splanchnic cryoneurolysis, sphenopalatine ganglion nerve block/cryoneurolysis, inferior alveolar nerve block, intercostal cryoneurolysis, and cryoablation of painful bone metastases, notably in the setting of metastatic sarcoma.

Analysis of Nursing Care for Post Appendixitis Patients with Acute Pain Nursing Problems Through Providing Distraction Using a Stress Ball in the Kemoning Room Klungkung Regional General Hospital

Patients with appendicitis are a very common problem in the community. Complications that often arise due to appendicitis include perforation, so it is necessary to treat quickly for appendicectomy. Appendicectomy can cause complications such as acute pain, to overcome pain problems in patients, pain management is needed, namely distraction using stress balls. This Ners Final Scientific Work was carried out to determine the analysis of nursing care in post appendicitis patients with acute pain nursing problems through the provision of distraction using stress balls. The results of the assessment obtained the main complaints of the three patients were pain in the surgical wound in the lower right abdomen, a scale of 5-7, a nursing plan to provide distraction using a stress ball, nursing action by providing distraction using a stress ball carried out for 2 x meetings. The results of nursing evaluations carried out on the three managed cases showed that all of them experienced a decrease in pain from a moderate pain scale to a mild pain scale. It is recommended to Klungkung Regional General Hospital to establish distraction using stress ball as a standard operating procedure in pain management.

O-168 Clinical efficacy of virtual reality for acute pain and anxiety management during transvaginal oocyte retrieval for in vitro fertilization: a randomized controlled trial

Abstract Study question Does the use of virtual reality (VR) headsets during ultrasound-guided transvaginal oocyte retrieval (TVOR) reduce anxiety and pain scores of the patient? Summary answer In spite of high patient satisfaction rates, VR headset during TVOR is not superior to standard practice with regard to anxiety, pain and stress. What is known already Ultrasound-guided transvaginal follicle aspiration (TVOR) is an essential part of in vitro fertilization (IVF) treatments but is associated with significant discomfort, as many patients report insufficient analgesia. The experience of pain is a complex phenomenon, with simultaneous impact on cognitive, emotional, and behavioural function. Adequate pain relief and mitigation of anxiety during the procedure can be challenging. VR has emerged as a potent tool as it allows multiple sensory experiences to consume multiple portions of the finite attentional resources of the human brain. As a consequence, less cognitive capacity is available to process pain. Study design, size, duration Threehundred subfertile patients undergoing IVF treatment at our tertiary-care fertility center between february 2023 and july 2024 were included in this randomized trial. The sample size was calculated considering a power of at least 90% to detect superiority of the virtual reality versus standard care of TVOR with paracervical block, with a standard deviation (SD = 2,5), using a two-sided, t-test, at significance level alpha of 0.05, and a dropout rate of 10%. Participants/materials, setting, methods The standard care TVOR entails paracervical block after midazolam premedication 1mg/kg. During TVOR, we used Oncomfort®, a commercially available VR autohypnosis relaxation program designed for perioperative settings. The headmounted smartphone display with headphones provides image sound distraction with suggestive hypnosis techniques incorporated. Subjective variables of stress, anxiety and pain were evaluated at four different time points, i.e. before, during, immediately after and 5 days later, using questionnaires and the 10.0cm visual analog scale (VAS). Main results and the role of chance The VRgroup reported stress levels prior to TVOR at 4.5±2.6, during TVOR at 5.2±2.8, immediately after TVOR at 2.3±2.5 and five days after the TVOR at 3.3±3.0. This was respectively 12%, 10%, 15% and 8% lower than controls. Only during and immediately after TVOR differed significantly. Fear was also reduced, not significantly, in the VRgroup compared to controls: 4.0±2.6 (-11%), 3.5±2.7 (-13%), 1.6±2.1 (-11%) and 2.1±2.6 (-13%) at the consecutive timepoints. Pain levels in the VRgroup were respectively 17% (1.5±2.2), 4% (4.4±2.6), 9% (3.0±2.6) and 12.5% (1.4±2.0) lower than controls, not significant. The VRgroup report immersive state 5.9±2.7, satisfaction on VR 7.3±2.8 and 9.1±1.4 on support by medical staff. They report not liking the disability to follow the TVOR 6.6±3.3, and prefer medical staff over VR 6.6±3.2. Although 89,7%(130/145) recommend VR, only 82,1%(119/146) report VR helped them and 73,1%(106/145) would use VR again. Pain was modeled with a linear mixed model to evaluate the difference between VR and controls, for all different time points. The estimated difference was .204 (se=.196) in average while accounting for the repeated measures, showing no clear evidence that VR is beneficial. The difference was estimated even smaller at 0.002 when accounting for both stress and anxiety. Limitations, reasons for caution A population selection bias could exist, as patients were willing to accept VR. The short induction period of 2 minutes, although recommended by the VR itself, might influence the immersiveness into VR. The software of the tested VR system has, in the meantime, undergone updates and is thus maybe outdated Wider implications of the findings Pain management in ambulatory procedures should be multimodal and should include both pharmacological and non-pharmacological interventions. Offering patients a range of pain management options will increase the number of successful procedures, patient empowerment and improve patient experience and satisfaction. Trial registration number Yes

Assessing ChatGPT responses to patient questions on epidural steroid injections: A comparative study of general vs specific queries.

Assessing ChatGPT responses to patient questions on epidural steroid injections: A comparative study of general vs specific queries.

Differences in Neonatologist and Nurse Perceptions of Procedural Pain Intensity and Management

Differences in Neonatologist and Nurse Perceptions of Procedural Pain Intensity and Management

Efficacy of 25% dextrose gel in reducing procedural pain in preterm infants: a prospective observational study

Background: Preterm infants in neonatal intensive care units (NICUs) undergo frequent painful procedures, increasing their risk for adverse neurodevelopmental outcomes. Non-pharmacologic interventions are sought for safe, effective pain management. We evaluated the efficacy of 25% dextrose gel (Nanodex, Analeptik Biologicals) for procedural pain relief in preterm neonates. Methods: This prospective observational study enrolled 53 preterm infants over 12 months. 25% dextrose gel (Nanodex, Analeptik Biologicals) was administered buccally at 0.5 ml/kg, 2 minutes before procedures including venepuncture, intubation, heel prick, nasogastric/orogastric tube insertions, and retinopathy of prematurity (ROP) screening. Historical data was used as control group. Pain was assessed using the premature infant pain profile (PIPP) score. Results: The mean PIPP score across all procedures was significantly lower post-25% dextrose gel (mean: 6.9±1.9) compared to historical reference scores (mean: 11.2±2.1, p<0.001). The greatest reduction was observed during ROP screening. No adverse events were recorded. Conclusions: 25% dextrose gel is a safe and effective intervention for procedural pain management in preterm infants. Its routine use in NICU protocols should be considered.

Trends in Spinal Pain Procedure Volumes and Reimbursements: An Analysis of 20 Years of Medicare Data.

Chronic back/neck pain costs the United States around 250 billion dollars annually. Treatment strategies include medication, physical therapy, and specialized procedures. This study aimed to investigate the trends in procedural frequency and Medicare reimbursement rates for common back pain procedures. Data from 2000 to 2020 were extracted from Medicare Part B National Summary Data files, using Current Procedural Terminology (CPT) codes to identify reimbursement for cervical/thoracic and lumbar/sacral epidural injections, radiofrequency ablation, facet joint injections, and spinal cord stimulators (both percutaneous and paddle). Key metrics included annual total physician charges, reimbursements, and the number of procedures performed. From 2000 to 2020, 53,208,205 pain procedures were performed. The most common was lumbar/sacral epidural injections, followed by facet joint injections and radiofrequency ablations. Paddle SCS placement was the least common. Percutaneous SCS had the greatest volume growth, increasing from 3595 to 111,172 [+2992%], followed by lumbar/sacral epidural injections with 118,884 to 1,965,445 [+1553%], and cervical/thoracic epidural injections, 22,480-348,642 [+1451%]. All procedures saw a significant increase in volume except for facet joint injections. Inflation-adjusted reimbursement per service also increased, with paddle SCS demonstrating the largest increase ($618-$2960 [+379.0%]), followed by percutaneous SCS ($353-$1428 [+304.5%]) and cervical/thoracic epidural injections ($128-$153 [+19.5%]). Pain management procedures have increased in volume and reimbursement over the last 20 years. This increased reimbursement may allow for broader access to these procedures compared to prior decades and support a shift from traditional and more invasive surgical procedures to minimally invasive treatments for chronic pain patients.

The use of implanted port systems in the treatment of oncological chronic pain: case series

Cancer pain occurs in oncologic patients due to tissue damage, inflammation, nerve compression or the effects of treatment. Pain can significantly reduce the quality of life, but modern medicine offers effective approaches to its control. If pain relief is achieved only with high doses of opioids, the method of choice is interventional pain management procedures such as tunneled epidural catheters, fully implanted systems for intrathecal or epidural administration. Implantable port systems are an effective tool in the treatment of chronic cancer pain and provide convenient and long-term access to therapy. They allow the delivery of analgesics and other drugs directly to the spinal cord, minimizing side effects and improving the quality of life of patients. Implantable port systems significantly improve the quality of life of patients with chronic diseases or the need for regular treatment.

Impact of a Geriatric Medication Safety Initiative (GEMSI) Pharmacist-Driven Procedure on Opioid Use in a Transitional Care Unit.

Background: Millions of older people are hospitalized each year, and they often use pain medications during their stay. At the same time, about seven million people 65 years of age and older have filled at least one opioid prescription. Studies have found pharmacist-led interventions to minimize inappropriate prescribing and optimize medication regimens. These also may reduce adverse events and length of stay. Objective A pharmacist-driven procedure, the Geriatric Medication Safety Initiative (GEMSI), was created in May 2017. The primary outcome of this study was to examine the opioid morphine milligram equivalent per day (MMED) pre- and post-implementation of GEMSI. Secondary outcomes included length of stay (LOS) and acetaminophen use per day. Design This was a retrospective, single-center cohort study with pre- and post-implementation groups. Data were extracted via chart review to determine the reason for admission, length of stay, non-opioid pain medication usage, and MMED. Data are expressed as mean, standard deviation (SD), and n (%). Chi square, Mann Whitney U, and two sample t-tests were performed as appropriate. Setting A transitional care unit (TCU) in the state of New York that has achieved an Institute for Healthcare Improvement (IHI) for Age-Friendly health level 2 center designation. It is a short-term (usual maximum of 21 days) rehabilitation and acute care setting. Patients who are medically stable after their acute admission but need additional physical and/or occupational therapy are eligible for admission. Patients, Participants Patients greater than or equal to 65 years of age admitted to the TCU in 2016 or 2018 were included. Patients were excluded if they were acutely ill and/or transferred off the TCU. Intervention This was a single-center (ie, a short-term inpatient rehabilitation facility), retrospective, cohort chart review study that was exempted from Institutional Review Board (IRB) review. Results In total, 566 patients were included. The overall mean MMEDs pre- and post-GEMSI were 9.5 (+/- 18.0) compared to 8.5 (+/- 22.7) mg/day, respectively (P = 0.186). The TCU length of stay decreased from a mean of 12.4 to 11.1 days (P = 0.005) and the average acetaminophen use increased from 673 to 722 mg/day from pre- to post-GEMSI (P < 0.001). Lidocaine doses utilized per day were not statistically different between pre- to post-GEMSI (0.14 doses per day vs 0.20 doses per day; P = 0.798). In a subgroup analysis of patients who reported pain, the mean MMEDs were 15.3 (+/- 21.3) compared to 10.9 (+/- 18.7) mg/day, respectively (P = 0.038). Discussion This retrospective study demonstrates that the implementation of a pharmacist-driven procedure, such as GEMSI, is associated with decreased opioid exposure and increased use of non-opioid analgesics such as acetaminophen. By decreasing the exposure to opioid medications, we expect that patients are less likely to experience dose-dependent adverse effects of opioids. Conclusion A pharmacist-driven procedure for multimodal pain management was associated with a decreased MMED and reduced LOS. Future large-scale studies need to be conducted to replicate these results in different practice settings.

Factors Explaining Procedural Pain Management in Newborn Intensive Care Unit: A Cross- Sectional Study

Introduction: Recent research has highlighted the significant impact of procedural pain on critically ill neonates. However, effective pain management strategies to mitigate long-term negative consequences are still underutilized. Objective: To determine the effect of nurse factors on procedural pain management in neonates performed by neonatal nurses, when controlling organizational context factors and infant factors. Method: This study was cross-sectional correlation design. The participants consisted of 118 Thai NICU nurses. The Data collecting used by a self-report questionnaire. The descriptive statistics and hierarchical multiple regression analysis are used to analyze the data. Result: The findings showed that organizational supportive resources and nurse-physician collaboration had significantly positive effects on pain management in neonates (β = .349, p &lt; .001, and β = .362, p &lt; .001). Gestational age had a significant negative effect on pain management in neonates (β = -.414, p &lt; .001). Knowledge, attitude, and nurses’ experience of infant care had significant positive effects on pain management in neonates (β = .435, p &lt; .001, β = .257, p &lt; .01, and β = .236, p &lt; .01, respectively). When controlling for the organizational context factors and the infant factor, nurse factors still predicted procedural pain management in neonates. Together, the predictor variables explained 54.8% of the total variance of nurses’ pain management in neonates. It can conclude that nurse factors are important predictors of procedural pain management in neonates. Conclusion: Thus, there is a need for nurse empowerment and enhanced knowledge about neonatal pain assessment and management among NICU nurses.

Preoperative Analgesia in Midurethral Sling: A Cohort Study.

Stress urinary incontinence (SUI) is a common condition among adult women in the USA, with its prevalence expected to rise owing to an aging population. Midurethral sling (MUS) procedures are a well-established surgical treatment for SUI. Enhanced Recovery After Surgery (ERAS) protocols advocate for multimodal pain management strategies, including preoperative analgesia. However, limited data exist on the effectiveness of preoperative pain medications in MUS procedures. This study examines the impact of preoperative analgesia on postoperative pain scores and opioid consumption. A retrospective cohort study analyzed women who underwent MUS placement between 2018 and 2022 within a New England health care system. Patients were stratified by preoperative pain medication use. Primary outcomes included postoperative pain scores and opioid consumption. Secondary outcomes assessed anesthesia type, sling type, and operative time. Multivariable regression analyses adjusted for confounders. A total of 631 patients met the inclusion criteria, with 400 receiving preoperative pain medications. Patients with preoperative analgesia had significantly lower median postoperative pain scores (p = 0.013) and were more likely to achieve acceptable pain control (p = 0.014). However, adjusted analyses found no significant difference in opioid consumption or pain scores between groups. Preoperative pain medications were associated with improved pain scores in unadjusted analyses but did not demonstrate independent statistical significance after adjusting for confounders. These findings highlight the complexity of pain management in MUS procedures. Further randomized studies are needed to refine ERAS pain strategies in urogynecological surgery.

Dexmedetomidine for chronic pain patients with anxiety and depression: a propensity score matching cohort study

BackgroundChronic pain patients often experience moderate to severe anxiety and depressive symptoms. Growing evidence supporting dexmedetomidine as a potential treatment for mental health conditions, research on its application in chronic pain patients with comorbid anxiety and depression remains limited.MethodsPatients who received intravenous infusions of dexmedetomidine during their interventional pain management procedures from January to July 2024 were compared to those who underwent similar procedures without dexmedetomidine infusion during the same period, utilizing propensity score matching.ResultsA total of 290 patients were included in the analysis from January to July 2024. Propensity score matching resulted in 92 matched pairs for further analysis. At the one-month follow-up, the perioperative application of dexmedetomidine was associated with a greater improvement in anxiety and depression disorders, as measured by the Generalized Anxiety Disorder 7-item scale, showing a reduction of -4.43 points (95% CI, -4.98 to -3.88) compared to -2.42 points (95% CI, -2.97 to -1.87) for the local analgesia group and the Patient Health Questionnaire-9 scores indicated a reduction of -6.19 points (95% CI, -6.84 to -5.55) for the dexmedetomidine group versus -3.92 points (95% CI, -4.56 to -3.28) for the local analgesia group. The use of dexmedetomidine was also associated with a greater improvement of pain(-3.32 points vsurs -2.62 points).ConclusionsIntraoperative dexmedetomidine significantly improves anxiety and depression in patients with chronic pain. Therefore, dexmedetomidine may serve as a promising adjunctive treatment for chronic pain patients, particularly those with comorbid anxiety and depression.Clinical trial numberNot applicable.

(039) PAIN MANAGEMENT FOR OUTPATIENT INTRAUTERINE DEVICE (IUD) PROCEDURES - A COMPREHENSIVE TEN YEAR REVIEW OF THE LITERATURE

Abstract Introduction Although pain - both anticipated and procedural - is a common reason people who could benefit from an intrauterine device (IUD) do not do so, there is no standard guideline for pain management during outpatient IUD procedures. The CDC’s U.S. Selected Practice Recommendations for Contraceptive Use 2024 document offered updated recommendations for the provision of medications for IUD placement. The CDC recognized that the experience of pain is individualized and influenced by past experiences including trauma, depression and anxiety. While the CDC recommends offering pain relief, it does not provide an adequate summary of the available data in support of the recommended methods. Objective To examine and synthesize the findings from published works on pain management for outpatient IUD procedures over the past ten years. Methods A detailed search was performed in PubMed to identify papers examining pain management and outpatient gynecologic procedures. This review examined data as part of a larger study investigating pain management for all outpatient gynecologic procedures. Covidence software was used to explore and extract relevant data. To limit bias, at least two reviewers examined every study and reached a consensus on the study’s relevance to pain management and outpatient IUD procedures. This study focused on original research studies, especially randomized control studies. This study excluded studies dated before 2015, studies investigating the care of currently pregnant patients, studies that lacked a control group, reviews, and meta-analyses. Results Of 2537 screened studies, 2507 studies were excluded from this review. Of the remaining thirty studies, twenty-eight studies examined IUD insertion and pain relief, and two studies examined IUD removal and pain relief. All but two studies used visual analogue scale (VAS) data as a key result. The most common intervention studied was lidocaine (12 studies). Other pain relief methods included acupuncture, valsalva maneuver, vaginal dinoprostone, vaginal misoprostol, and NSAIDs. Conclusions Many effective pain management tools for outpatient IUD procedures exist and merit consideration when offering these procedures. Disclosure No.

Acupuncture for procedural pain in newborn infants.

Procedural pain management in newborns, particularly those in neonatal intensive care units (NICUs), presents challenges due to limited safe and effective options. Acupuncture, a Traditional Chinese Medicine practice, has emerged as a potential alternative for pain relief in this population. To assess the benefits and harms of acupuncture in newborn infants undergoing painful procedures. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and clinical trial registries up to August 2023. We checked the references of included studies and related systematic reviews. We included parallel and cross-over randomized controlled trials (RCTs) comparing acupuncture with no treatment or sham treatment; any non-pharmacological treatment; any pharmacological treatment; or one type of acupuncture compared to another type of acupuncture. Our outcomes were: pain scores; harms; parental, family, and caregiver satisfaction with the intervention; use of additional pharmacological intervention for pain relief; episodes of bradycardia/apnea/desaturation; neonatal mortality; mortality during initial hospitalization; intraventricular hemorrhage; late-onset sepsis; duration of hospital stay; major neurodevelopmental disability. We used Cochrane's RoB 1 tool for RCTs. We conducted meta-analyses using fixed-effect models to calculate risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) or standardized mean difference (SMD, when combining different pain scales) and standard deviation for continuous outcomes. We summarized the certainty of evidence according to the GRADE approach. We included 11 RCTs enrolling 852 infants. Five studies compared acupuncture to no treatment or sham treatment; four studies to non-pharmacological treatment (oral sucrose or glucose); and two studies compared acupuncture to other types of Traditional Chinese Medicine treatments, which we refer to as 'type B acupuncture,' such as foot massage or reflexology. No studies compared acupuncture to any pharmacological treatment. We identified four ongoing studies. We have listed outcomes reported in at least one study. Acupuncture compared to no treatment or sham treatment Acupuncture may reduce pain assessed during the procedure with any validated scale compared to no intervention (SMD -0.56, 95% CI -0.75 to -0.37; 7 studies, 471 infants; low-certainty evidence). It may result in little to no difference in any harms compared to no intervention (RR 0.35, 95% CI 0.01 to 8.31; 2 studies, 138 infants; low-certainty evidence). Acupuncture compared to any non-pharmacological treatment The evidence is very uncertain about the effect of acupuncture on pain assessed with a validated scale during the procedure compared to non-pharmacological intervention (SMD 0.29, 95% CI 0.04 to 0.54; 4 studies, 267 infants; very low-certainty evidence). Acupuncture may result in little to no difference in any harms compared to non-pharmacological treatment (RR not estimable, RD 0.00, 95% CI -0.03 to 0.03; 3 studies, 247 infants; low-certainty evidence). Acupuncture type A (e.g. penetration of the skin with a needle) compared to acupuncture type B (e.g. foot massage or reflexology) The evidence is very uncertain about the effect of acupressure on pain assessed with any validated scale during the procedure compared to foot massage (SMD 0.05, 95% CI -0.26 to 0.36; 2 studies, 163 infants; very low-certainty evidence). Acupuncture may reduce pain assessed with different scales during the procedure, with little to no difference in any harms, when compared to no intervention. The evidence is very uncertain about the effect of acupuncture on pain assessed with different scales during the procedure when compared to any non-pharmacological treatment; acupuncture may result in little to no difference in any harms. The evidence is very uncertain about the effect of acupressure on pain assessed during the procedure when compared to foot massage or reflexology. This Cochrane review had no dedicated funding. Protocol (2023): doi.org/10.1002/14651858.CD015894.