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    Distraction Shown to Reduce Pain of Anesthesia Injection

    By Nancy Deutsch, contributor.    

    Distracting patients while they receive anesthesia may significantly reduce their pain, a new study suggests.

    According to the research, the distraction may reduce both pain experienced at the time of the injection and pain experienced after surgery.

    In the study led by Tomoko Higashi, M.D., instructor in anesthesiology and critical care medicine at Yokohama City University Medical Center in Japan, half of the patients were asked to count aloud as they received 2 kg/mg of medium-chain and long-chain triglycerides propofol (MCT/LCT). The MCT/LCT propofol was given at a rate of 0.1ml/kg/10 seconds. The medication was given through a peripheral IV route, via a proximal three-way stopcock.

    After surgery, the patients were all asked to rate their pain during the rapid injection. Those that counted aloud rated their pain as much lower than those who had not been distracted by counting aloud.

    In a recent interview, Higashi said she was not surprised by the results, although the magnitude of the difference did surprise her.

    “Clinical experiences told us to talk to patients and to distract patients’ attention from puncture for blood draws or injections,” she said. “Our study showed that the simplified task, such as counting numbers, significantly reduced the propofol injection pain and quantified the effect of the distraction.”

    Half of the study’s 92 patients were not distracted during anesthesia induction, while the other half were asked to count down from 100 while receiving the drug. After surgery, the patients were asked about their pain at the time their anesthesia was given, as well as their pain after surgery. The data was analyzed using Fisher’s exact test, which is a statistical significance test used to analyze data where sample sizes are relatively small.

    In the control group, only one of the 46 patients who were asked to count recalled pain at the injection site, while none reported pain following surgery. However, in the group that was not asked to count, 19 of the 46 patients reported pain at the injection site, and 10 of those 19 remembered pain after surgery.

    Higashi said she doesn’t know if other types of distraction would be as successful as counting, but said she has had good anecdotal results with the use of a cartoon video while medicating children, or asking them to breathe in through an oxygen mask. She has also found it useful to use vanilla-flavored oxygen, and to ask the child to guess as to the flavor being used.

    She also suggested that distraction works best the first time it is used, but may not be as successful at subsequent attempts if the patient realizes what is taking place as he or she counts.

    “It seems like the effect of counting on pain may vary, depending on the situation, or the balance between the intensity of pain and the level of the psychological task,” Higashi said.

    Considering how well distraction therapy worked in this study, however, she would recommend that nurses and physicians consider employing the technique to reduce patients’ pain, without side effects. “Distraction is a simple and effective alleviator [of pain],” Higashi said. “Our study revealed how much distraction influenced the sense of pain. We hope medical staff recognize the importance of the effect of distraction and try our method.”

    Higashi also encouraged practitioners to try other distraction techniques that have been found to be effective, and suggested that further, more detailed studies are warranted.



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