Institute of Health Sciences, Pamukkale University, Denizli, Turkey.
Faculty of Health Sciences, Nursing Department, Pamukkale University, Denizli, Turkey.
J Adv Nurs. 2019 Dec;75(12):3346-3361. doi: 10.1111/jan.14183. Epub 2019 Sep 13.
To assess the effectiveness of physical-procedural interventions in reducing pain during intramuscular injections.
Systematic review and meta-analysis.
English keywords were used to search databases [MEDLINE (OVID, Ebsco), SCOPUS, Science Direct, COCHRANE and the reference lists from retrieved articles] from their inception to November 2017 and randomized and quasi-experimental trials were selected based on inclusion and exclusion criteria. The standardized mean difference and random effects model were used.
From 2,318 articles, 15 articles (1996-2017) met the criteria for the meta-analysis. Physical-procedural interventions described in the articles were included in this systematic review. The overall standardized mean difference was 0.595 (95% confidence interval (CI) = 0.417-0.773), indicating a moderate effect on pain levels. Generally, these interventions (two-needle technique, acupressure, manual pressure, ShotBlocker, Z-technique, air-lock technique, injection site postinjection massage, and speed of injection) have been found to moderately reduce pain.
It seems difficult to conclude that a single intervention reduces pain in adults. However, we can state that the most effective interventions for reducing pain during intramuscular injections in adults involve the ventrogluteal site, the Z-technique, and manual pressure.
The systematic review will provide guidance to clinicians, staff, and educator nurses and future studies. The systematic review will help nurses and educators apply techniques based on evidence in any setting. The systematic review will guide well-designed and well-reported studies to contribute to the accumulation of evidence in nursing research.
评估物理程序性干预在减少肌肉内注射疼痛中的有效性。
系统评价和荟萃分析。
使用英文关键词在数据库[MEDLINE（OVID、Ebsco）、SCOPUS、Science Direct、COCHRANE 和检索文章的参考文献列表]中进行搜索，从创建到 2017 年 11 月，并根据纳入和排除标准选择随机和准实验性试验。使用标准化均数差和随机效应模型。
从 2318 篇文章中，有 15 篇文章（1996-2017 年）符合荟萃分析的标准。本文系统综述中纳入了文章中描述的物理程序性干预措施。总体标准化均数差为 0.595（95%置信区间（CI）=0.417-0.773），表明对疼痛水平有中度影响。一般来说，这些干预措施（双针技术、指压、手动按压、ShotBlocker、Z 技术、气锁技术、注射部位注射后按摩和注射速度）已被发现能适度减轻疼痛。
很难得出单一干预措施能减轻成年人疼痛的结论。然而，我们可以说，减轻成年人肌肉内注射疼痛最有效的干预措施涉及臀肌外侧部位、Z 技术和手动按压。
系统评价将为临床医生、工作人员、教育护士和未来的研究提供指导。系统评价将帮助护士和教育者在任何环境下基于证据应用技术。系统评价将指导设计良好和报告良好的研究，为护理研究中的证据积累做出贡献。
