A randomized clinical trial found that a vibrating anesthesia device relieved injection site pain during skin cancer resection procedures involving local anesthesia, both in those patients who tended to cause catastrophic pain, and those who did not. Panayiota Govas, MD, University of Pittsburgh, reported a 79.4 percent drop in Numerical Rating Scale (NRS) scores in patients who used the device that resulted in no catastrophic pain during local anesthetic injections, compared with a 25.5 percent drop in those who used anesthesia. with colleagues.
The findings, published online in JAMA Facial Plastic Surgery, confirm that those who experienced catastrophic pain before surgery reported higher levels of pain, the researchers noted. “The application of vibration during local anesthetic injection resulted in minimal clinically important differences in pain levels in patients with catastrophic pain and a clinically important difference in pain levels in patients without pain,” the authors wrote. clinical differences,” the authors wrote.
In a clinical setting, patients with catastrophic pain can be identified by assessing their expectations of pain levels, as indicated by an NRS score of over 4, who would benefit from vibration during local anesthetic injections, the team continued. Dr. Hayley Goldbach of the University of California, Irvine, noted that previous research has shown that providers can use adjunctive methods to reduce the pain that patients experience during surgery, especially during ambulatory procedures. try out.
Goldbach told Medicine Today that the study gives us “more information about what types of patients come into the office and whether we need to change our strategy.” “In this case, this suggests that the vibratory device was helpful in both groups of patients, but may be more useful in those groups who are less expecting pain.”
Such games are somewhat distracting, says Neil Tanna, MD, MBA at Northwell Health in Great Neck, New York. “I think there are also audiovisual ways to divert someone and potentially reduce pain, or at least expect it,” he told MedPage Today. “I know that sometimes we use virtual reality for patients who want to be distracted, and I know of studies that have used music or virtual reality to distract patients.”
“There are certainly other techniques that are commonly used, including talking to the patient, topical numbing agents and even music, but a reusable vibratory device is something of interest to many practitioners because it is both economical and environmentally friendly,” Goldbach said. And it has actually been shown to significantly reduce patient suffering.” For the study, Govas and colleagues randomly assigned 49 patients to a treatment group using a vibrating anesthesia device on (VAD ON), placing 52 patients in the Off state (VAD OFF). Participants (average age 66) had 101 unique events.
Patients participated in a training session to solve trial questions based on an NRS of 11, ranging from 0 (no pain) to 11 (indicating the worst imaginable pain), and provided descriptive adjectives about how they felt. The VAD is a hand-held, battery-operated, handheld device approximately 10 cm in length that is placed on the training site approximately 5 cm from the patient’s treatment site for 15 seconds in the closed state. Participants were then asked to use the NRS score to describe the level of pain they experienced and describe what they felt on their skin. Then repeat the process, but this time the VAD is in open mode.
All participants were over 18 years of age and were seen at one center for surgical resection, Mohs microscopy, and/or other skin cancer resections. Patients completed a preoperative survey on baseline pain, medication use, and expected pain. Analysis is by intent. Participants were excluded due to lack of attendance, language barriers, inability to follow directions, refusal to attend during appointments, and procedures cancelled due to medical concerns.
Patients without catastrophic pain had a mean NRS score (iNRS) of 1.44 during anesthesia injection, compared with 2.27 in patients without catastrophic pain (P = 0.03). The only statistically significant variable affecting the iNRS score was VAD ON (P = 0.03). The mean iNRS score decreased by 38.9% for all participants with VAD ON compared to VAD OFF (2.04 vs 1.24).
A limitation of the trial, the researchers said, was that it was not possible to completely blind clinicians and patients to assigned interventions due to the nature of vibration and possible selection bias, as this was a selective study in which patients were more likely to opt out of participation. catastrophic pain. Another limitation, the team added, is the generalizability of the study, as it relies on a single operator at a single center.
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