From the *Texas A&M Health Science Center/Christus Spohn, Corpus Christi; and †Texas Tech University, Lubbock, TX.
Reg Anesth Pain Med. 2017 Jul/Aug;42(4):458-461. doi: 10.1097/AAP.0000000000000584.
The infiltration of local anesthetic is consistently described as painful by patients. Vibration anesthesia has been studied in the dental literature as a promising tool to alleviate the pain from dental nerve blocks. Many of these studies used a specific device, the DentalVibe. To date, there have not been any studies applying this technology to digital blocks of the hand in human subjects. We hypothesized that the use of microvibratory stimulation during digital blocks of the hand would decrease pain reported by patients.
This was a randomized controlled trial of consenting adult emergency department patients who received digital block anesthesia for hand digit therapy when study authors were present. The study period was 24 months at an academic emergency department. A sample size of 50 injections (25 subjects) was necessary for a power of 80% to detect a mean difference of 2 (SD, 2.5) on the pain scale. A 2-sided dorsal injection approach was used for digital blocks. Subjects were randomized to either intervention (vibration) for the first injection or sham (device off). Both intervention and sham were held in place for 5 seconds prior to and during injection. Subjects were given 2 mL of 1% lidocaine and asked to rate the injection pain on a 1- to 10-point scale. This process was then repeated. Mean pain scores were compared using paired t tests. Our primary outcome was the difference in mean injection pain score between sham versus intervention groups.
There were 25 patients in the study group (mean age, 35.52 years [range, 18-58 years]; 8 females; 11 non-Hispanic white). The mean injection pain score in the sham group was 4.28 (95% confidence interval [CI], 3.14-5.42), and in the intervention group, the mean pain score was 2.52 (95% CI, 1.62-3.42). For the primary outcome, the mean injection pain score difference between the sham and intervention groups across all subjects was 1.76 (95% CI, 0.49-3.03; P = 0.009). The mean injection pain score differences were similar across groups: females versus males (0.24; 95% CI, -2.31 to 2.79; P = 0.85), non-Hispanic whites versus other races (0.76; 95% CI, -1.78 to 3.29; P = 0.54), intervention first versus sham first (-0.43; 95% CI, -3.25 to 2.40; P = 0.75).
Our results show a statistically significant difference in mean injection pain score during digital block of the hand when the DentalVibe device is used for vibration anesthesia. Larger studies are warranted to confirm our findings.
患者普遍反映局部麻醉的渗透过程疼痛。振动麻醉已在牙科文献中被研究作为减轻牙科神经阻滞疼痛的一种有前途的工具。这些研究中的许多都使用了一种特定的设备，即 DentalVibe。迄今为止，还没有任何研究将这项技术应用于人体手部的数字化阻滞。我们假设在手部数字化阻滞期间使用微振动刺激会降低患者报告的疼痛。
这是一项在学术急诊部门进行的、同意参加的成年急诊患者的随机对照试验，当研究作者在场时，这些患者接受手部数字阻滞麻醉进行手部数字治疗。研究期间为 24 个月。在 80%的功率下，需要 50 次注射（25 名受试者）的样本量，以检测疼痛量表上 2（标准差，2.5）的平均差异。采用双侧背侧注射方法进行数字阻滞。受试者随机分为干预组（振动）第一针或假（设备关闭）。在注射前和注射过程中，干预组和假组都保持 5 秒。给予受试者 2 mL 1%利多卡因，并在 1 到 10 分的量表上对注射疼痛进行评分。然后重复此过程。使用配对 t 检验比较平均疼痛评分。我们的主要结局是在假组与干预组之间的平均注射疼痛评分差异。
研究组有 25 名患者（平均年龄 35.52 岁[范围 18-58 岁]；8 名女性；11 名非西班牙裔白人）。假组的平均注射疼痛评分为 4.28（95%置信区间[CI]，3.14-5.42），干预组的平均疼痛评分为 2.52（95%CI，1.62-3.42）。对于主要结局，所有受试者中假组和干预组之间的平均注射疼痛评分差异为 1.76（95%CI，0.49-3.03；P = 0.009）。两组之间的平均注射疼痛评分差异相似：女性与男性（0.24；95%CI，-2.31 至 2.79；P = 0.85），非西班牙裔白人与其他种族（0.76；95%CI，-1.78 至 3.29；P = 0.54），干预第一针与假第一针（-0.43；95%CI，-3.25 至 2.40；P = 0.75）。
我们的结果表明，在手部数字化阻滞时使用 DentalVibe 设备进行振动麻醉时，平均注射疼痛评分有统计学显著差异。需要更大的研究来证实我们的发现。
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