Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.
Emerg Med J. 2018 Feb;35(2):103-107. doi: 10.1136/emermed-2017-206585. Epub 2017 Oct 12.
Subcutaneous local anaesthetic injection can be painful to patients in the ED. We evaluated the effect of cryotherapy by application of an ice cube to the injection site prior to injection in patients with simple lacerations.
We conducted a prospective, randomised, controlled trial in consented patients with simple lacerations needing primary repair at a single emergency centre from April to July 2016. We randomly assigned patients undergoing repair for simple lacerations to either the cryotherapy group or the control group (standard care; no cryotherapy or other pretreatment of the injection site). In cryotherapy group subjects, we applied an ice cube (size: 1.5×1.5×1.5 cm) placed inside a sterile glove on the wound at the anticipated subcutaneous lidocaine injection site for 2 min prior to injection. The primary outcome was a subjective numeric rating (0-10 scale) of the perceived pain from the subcutaneous local anaesthetic injections. Secondary outcomes were (a) perceived pain on a numeric scale for cryotherapy itself, that is, pain from contact of the ice cube/glove with the skin and (b) the rate of complications after primary laceration repair.
Fifty patients were enrolled, consented and randomised, with 25 in the cryotherapy group and 25 in the control group. The numeric rating scale for subcutaneous anaesthetic injections was median, IQR, 95% CI 2.0 (1 to 3.5), 1.81 to 3.47, respectively, in the cryotherapy group and 5.0 (3 to 7), 3.91 to 6.05 in the control group (Mann-Whitney U=147.50, p=0.001). No wound complications occurred in either group. The numeric rating scale for cryotherapy itself was median, IQR, 95% CI: 2.0 (1 to 3.5), 1.90 to 3.70.
Pre-emptive topical injection site cryotherapy lasting 2 min before subcutaneous local anaesthetic injections can significantly reduce perceived pain from subcutaneous local anaesthetic injections in patients presenting for simple laceration repair.
KCT0001990.
皮下局部麻醉注射会给急诊科的患者带来疼痛。我们评估了在注射部位应用冰敷的效果，即在注射前将一个冰块应用于注射部位，观察其对简单撕裂伤患者的影响。
我们于 2016 年 4 月至 7 月在一家单一急诊中心进行了一项前瞻性、随机、对照试验，纳入需要进行初次修复的简单撕裂伤患者，并进行同意。我们将接受简单撕裂伤修复的患者随机分为冰敷组或对照组（标准护理；不进行冰敷或注射部位的其他预处理）。在冰敷组中，我们将一个无菌手套内的 1.5×1.5×1.5cm 的冰块应用于预期的皮下利多卡因注射部位的伤口上，持续 2 分钟，然后再进行注射。主要结局是患者对皮下局部麻醉注射的感知疼痛进行主观数字评分（0-10 分）。次要结局包括（a）冰敷本身引起的感知疼痛的数字评分，即冰块/手套与皮肤接触引起的疼痛，以及（b）初次撕裂伤修复后的并发症发生率。
共有 50 名患者入组、同意并随机分组，其中 25 名患者在冰敷组，25 名患者在对照组。冰敷组皮下麻醉注射的数字评分中位数、四分位距、95%CI 分别为 2.0（1 至 3.5），1.81 至 3.47；对照组为 5.0（3 至 7），3.91 至 6.05（Mann-Whitney U=147.50，p=0.001）。两组均未发生伤口并发症。冰敷本身的数字评分中位数、四分位距、95%CI 为 2.0（1 至 3.5），1.90 至 3.70。
在进行皮下局部麻醉注射前，对注射部位进行持续 2 分钟的预先局部注射部位冰敷，可以显著减轻接受简单撕裂伤修复的患者对皮下局部麻醉注射的感知疼痛。
KCT0001990。
