Gu Brian, Williams Ryan, Rodgers Jake, Boehnke Blair, Rodgers Jeffrey
DMOS Orthopaedic Centers, West Des Moines, IA.
DMU College of Osteopathic Medicine, Des Moines, IA.
J Hand Surg Glob Online. 2023 Apr 14;5(4):397-400. doi: 10.1016/j.jhsg.2023.03.006. eCollection 2023 Jul.
Topical refrigerant spray is commonly used with routine hand injections despite mixed evidence about its efficacy in reducing the pain experience. We hypothesize that the use of topical refrigerant spray decreases the pain experience of an instantaneous noxious stimulus.
Eighty adult volunteer participants were enrolled in the study. We constructed an instrument using the smooth end of a Kirschner wire mounted to the spring of a ballpoint pen to apply an instantaneous noxious stimulus to the long (middle) finger proximal nail fold. Participants completed two trials and were randomized to receive the topical refrigerant spray before either the first or second stimulus and on either the left or right side. Participants were asked to rate the pain of each experience using an 11-point Likert scale and indicate which condition they preferred, if any.
The mean pain ratings for the spray and no-spray conditions were 2.0 and 4.3, respectively, giving a mean difference of -2.3 ( < .001, α = 0.05). Subgroup analysis showed no significant effect of sex or medical versus nonmedical occupation ( = .28 and .11 respectively) on the mean difference in pain rating between the two conditions. Participants who received the spray first had a higher mean difference in pain rating (2.7) than that in those who received it second (1.9). Fifty-nine participants preferred the spray, whereas 21 participants either preferred no spray or had no preference ( < .0001).
The use of topical refrigerant spray significantly decreased the perception of pain from an instantaneous noxious stimulus. A significant majority of participants also preferred the topical refrigerant spray condition. The use of topical refrigerant spray for painful procedures, such as needle insertions, may improve the overall patient experience.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.
尽管关于局部冷冻剂喷雾在减轻疼痛体验方面的疗效存在混合证据，但在常规手部注射时仍普遍使用。我们假设局部冷冻剂喷雾的使用可降低对瞬时有害刺激的疼痛体验。
80名成年志愿者参与了该研究。我们制作了一种器械，使用安装在圆珠笔弹簧上的克氏针光滑末端，对示指（中指）近侧甲襞施加瞬时有害刺激。参与者完成两项试验，并随机分为在第一次或第二次刺激前以及在左侧或右侧接受局部冷冻剂喷雾。要求参与者使用11点李克特量表对每次体验的疼痛进行评分，并指出他们更喜欢哪种情况（如果有）。
喷雾组和无喷雾组的平均疼痛评分分别为2.0和4.3，平均差值为-2.3（P<0.001，α=0.05）。亚组分析显示，性别或医疗职业与非医疗职业对两种情况之间疼痛评分平均差值均无显著影响（分别为P=0.28和P=0.11）。先接受喷雾的参与者疼痛评分平均差值（2.7）高于后接受喷雾的参与者（1.9）。59名参与者更喜欢喷雾，而21名参与者要么更喜欢不使用喷雾，要么没有偏好（P<0.0001）。
局部冷冻剂喷雾的使用显著降低了对瞬时有害刺激的疼痛感知。绝大多数参与者也更喜欢局部冷冻剂喷雾的情况。在诸如针刺等疼痛操作中使用局部冷冻剂喷雾可能会改善患者的整体体验。
研究类型/证据水平：治疗性I级。
