Department of Anesthesiology and Reanimation, Medical Faculty, Gaziosmanpasa University, 60300, Tokat, Turkey,
J Anesth. 2013 Jun;27(3):407-11. doi: 10.1007/s00540-012-1540-1. Epub 2012 Dec 14.
Intravenous cannulation is a painful and stressful procedure. The objective of this study was to compare the analgesic efficacy of the eutectic mixture of local anesthetics (EMLA(®)) with that of the Valsalva maneuver in adult patients during i.v. cannulation.
One hundred ninety-five patients were randomized prospectively to three groups. The dorsum of the nondominant hand was covered with a thick paste of 2.5 g of EMLA(®) cream in the EMLA(®) group (group E) and left for a minimum of 30 min before venipuncture. In the control group (group C), the same procedure was applied except that Vaseline(®) was used instead of the EMLA(®). The Valsalva group (group V) were punctured during a Valsalva maneuver. The patients were placed in the supine position during venipuncture. The patients then scored the amount of pain on cannulation using an 11-point numerical rating scale (NRS; 0 = no pain, 10 = extreme pain).
Thirteen patients were excluded from the analysis due to failed cannulation. There was no difference in the demographic profiles of the groups (p > 0.05). The success of VP was significantly higher in group V than in groups E and C (p < 0.001). The median pain score as assessed by the NRS after venipuncture in group C was 3 (range 0-9), whereas the median pain values in groups E and V were 2 (range 0-7) and 2 (range 1-8).
The Valsalva maneuver yields similar results to the EMLA(®) in terms of pain reduction during venipuncture.
静脉穿刺是一种痛苦且有压力的操作。本研究的目的是比较在成人患者静脉穿刺时，局麻药混合物（EMLA®）与瓦尔萨尔瓦动作（Valsalva maneuver）的镇痛效果。
195 名患者前瞻性随机分为三组。在 EMLA®组（组 E）中，将 2.5 g 的 EMLA®乳膏厚糊剂涂于非优势手的手背，至少 30 分钟后再进行静脉穿刺。在对照组（组 C）中，除了使用凡士林（Vaseline®）代替 EMLA®外，进行相同的操作。在瓦尔萨尔瓦组（组 V）中，在进行瓦尔萨尔瓦动作时进行穿刺。患者在静脉穿刺时被置于仰卧位。然后，患者使用 11 点数字评分量表（NRS；0=无痛，10=极度疼痛）对穿刺时的疼痛程度进行评分。
由于穿刺失败，有 13 名患者被排除在分析之外。各组的人口统计学特征无差异（p>0.05）。与组 E 和组 C 相比，组 V 的 VP 成功率显著更高（p<0.001）。组 C 静脉穿刺后 NRS 评估的中位数疼痛评分为 3 分（范围 0-9），而组 E 和组 V 的中位数疼痛值分别为 2 分（范围 0-7）和 2 分（范围 1-8）。
在静脉穿刺期间，瓦尔萨尔瓦动作在减轻疼痛方面与 EMLA®具有相似的效果。
