Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.
Department of Nursing, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, P.R. China.
J Vasc Access. 2024 Sep;25(5):1576-1583. doi: 10.1177/11297298231169155. Epub 2023 Jun 19.
Totally implantable access port (TIAP) is a subcutaneously implanted, long-term infusion device that is widely used in oncology patients. However, multiple needle insertions into TIAP may lead to pain, anxiety, and dread in patients. This study aimed to compare the effectiveness of Valsalva maneuver, eutectic mixture of local anesthetics (EMLA) cream, and the combination of both in relieving pain of cannulations on TIAP.
This was a prospective randomized controlled study. We included 223 patients treated with antineoplastic drugs and randomized them into four groups: EMLA Group (Group E), control Group (Group C), Valsalva maneuver Group (Group V), and EMLA cream combing with Valsalva maneuver Group (Group EV). Each group was given the corresponding intervention before non-coring needle insertion. The data on pain scores and overall comfort were collected by numerical pain rating scale (NPRS) and visual analog scale (VAS).
Group E and Group EV experienced the least amount of pain scores in needle insertion, which was significantly lower than Group V and Group C ( < 0.05). Meanwhile, Group E and Group EV obtained the highest comfort level, which was significantly higher than group C ( < 0.05). Fifteen patients developed localized skin erythema after the application of medical Vaseline or EMLA cream and subsided within half an hour after rubbing.
EMLA cream is a safe and effective way to alleviate pain during non-coring needle insertion in TIAP and enhance the overall comfort of patients. We recommend applying EMLA cream 1 h before needle insertion of TIAP, especially in patients having needle phobia or high pain scores from previous non-coring needle insertion.
完全植入式输液港（TIAP）是一种皮下植入的长期输液装置，广泛应用于肿瘤患者。然而，多次向 TIAP 中插入针头可能会导致患者感到疼痛、焦虑和恐惧。本研究旨在比较瓦尔萨尔瓦动作、复方利多卡因乳膏（EMLA）和两者联合应用在缓解 TIAP 穿刺疼痛方面的效果。
这是一项前瞻性随机对照研究。我们纳入了 223 名接受抗肿瘤药物治疗的患者，并将其随机分为四组：EMLA 组（Group E）、对照组（Group C）、瓦尔萨尔瓦动作组（Group V）和 EMLA 乳膏联合瓦尔萨尔瓦动作组（Group EV）。每组在非穿透性针头插入前给予相应的干预措施。通过数字疼痛评分量表（NPRS）和视觉模拟评分量表（VAS）收集疼痛评分和总体舒适度的数据。
在针头插入时，Group E 和 Group EV 组的疼痛评分最低，明显低于 Group V 和 Group C 组（ < 0.05）。同时，Group E 和 Group EV 组获得了最高的舒适度水平，明显高于 Group C 组（ < 0.05）。在应用医用凡士林或 EMLA 乳膏后，有 15 名患者出现局部皮肤红斑，半小时后揉搓后消退。
EMLA 乳膏是一种安全有效的缓解 TIAP 非穿透性针头插入时疼痛的方法，可提高患者的整体舒适度。我们建议在 TIAP 针头插入前 1 小时应用 EMLA 乳膏，尤其是在有针头恐惧症或之前非穿透性针头插入疼痛评分较高的患者中。
