The Effect of Pain Relieving Intervention During Infiltration among Gamma Knife Surgery Patients for Stereotactic Frame Fixation

Young Jun Jang; Hyeon Ok Kim

doi:10.4040/jkan.2018.48.2.221

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Jang and Kim: The Effect of Pain Relieving Intervention During Infiltration among Gamma Knife Surgery Patients for Stereotactic Frame Fixation

Original Article

J Korean Acad Nurs 2018;48(2):221-231.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.2.221

The Effect of Pain Relieving Intervention During Infiltration among Gamma Knife Surgery Patients for Stereotactic Frame Fixation

Young Jun Jang¹, Hyeon Ok Kim^2,

¹Department of Nursing, Chonbuk National University Hospital

²College of Nursing · Research Institute of Nursing Science, Chonbuk National University, Jeonju, Korea

Address reprint requests to : Kim, Hyeon Ok College of Nursing · Research Institute of Nursing Science, Chonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, Korea Tel: +82-63-270-3120 Fax: +82-63-270-3127 E-mail: khok@jbnu.ac.kr

Received 29 November 2017 Revised 11 April 2018 Accepted 11 April 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to compare the effects of three interventions on pain, blood pressure, and pulse rate during infiltration anesthesia in patients about to undergo gamma knife surgeries.

Methods

The three interventions employed in a university-affiliated Hospital in J City, South Korea were as follows: EMLA cream plus Vapocoolant spray (Vapocoolant, n=30), EMLA cream plus 10.0% Lidocaine spray (Lidocaine, n=30), and EMLA cream only (EMLA, n=30). The equivalent control-group pre test - post test study design was used. Pain was assessed subjectively using the numeric rating scale (NRS) and objectively using a Galvanic Skin Response (GSR) tester. NRS scores were assessed after infiltration anesthesia and the GSR was assessed during infiltration anesthesia. Blood pressure and pulse rate were assessed twice: before and after infiltration anesthesia. Data were collected between August 3, 2016 and March 24, 2017.

Results

NRS scores after infiltration anesthesia and the GSR during infiltration anesthesia were significantly lower in the Vapocoolant group than in the Lidocaine and EMLA groups (F=13.56, p<.001 and F=14.43, p<.001, respectively). The increase in systolic blood pressure (F=4.77, p=.011) and in pulse rates (F=4.78, p=.011) before and after infiltration anesthesia were significantly smaller in the Vapocoolant group than in the Lidocaine and EMLA groups; however, no significant differences were observed in diastolic blood pressures (F=1.51, p=.227).

Conclusion

EMLA cream plus Vapocoolant spray was the most effective intervention to relieve pain and to lower increase in systolic blood pressure and pulse rate caused by infiltration anesthesia for stereotactic frame fixation. Thus, application of Vapocoolant spray in addition to EMLA cream is highly recommended as a nursing intervention for patients undergoing gamma knife surgeries.

Keywords: Neurosurgery, Pain, Local Anesthesia, Galvanic Skin Response, Nursing

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Figure 1.

Randomized controlled trial flow diagram.

Figure 2.

Flow of the study.

Table 1.

Homogeneity Test for Characteristics between Groups (N=90)

Charicteristics	Categories	Total (n=90)	EMLA cream plus 10.0% Lidocaine spray group (n=30)	EMLA cream plus Vapocoolant spray group (n=30)	EMLA cream only group (n=30)	F or χ²	p
		Mean (SD) or n (%)	Mean (SD) or n (%)	Mean (SD) or n (%)	Mean (SD) or n (%)
General characteristics
Age (yrs)		59.18 (13.3)	57.00 (15.2)	61.53 (12.9)	59.00 (11.6)	0.87	.422
Gender	Female	41 (45.6)	13 (43.3)	11 (36.7)	17 (56.7)	2.51	.285
	Male	49 (54.4)	17 (56.7)	19 (63.3)	13 (43.3)
Marital status	Single	14 (15.6)	7 (23.3)	5 (16.7)	2 (6.7)	4.98^†	.238
	Married	73 (81.1)	23 (76.7)	23 (76.6)	27 (90.0)
	Divorced/Widowed	3 (3.3)	0 (0.0)	2 (6.7)	1 (3.3)
Monthly income of family	<100	57 (63.3)	18 (60.0)	22 (73.3)	17 (56.7)	2.27	.686
(10,000 won)	100~199	15 (16.7)	6 (20.0)	3 (10.0)	6 (20.0)
	200≤	18 (20.0)	6 (20.0)	5 (16.7)	7 (23.3)
Educational level	Elementary	29 (32.2)	8 (26.7)	14 (46.6)	7 (23.3)	8.14	.228
	Middle	16 (17.8)	7 (23.3)	3 (10.0)	6 (20.0)
	High	31 (34.4)	8 (26.7)	11 (36.7)	12 (40.0)
	≥College	14 (15.6)	7 (23.3)	2 (6.7)	5 (16.7)
Job	Yes	30 (33.3)	14 (46.7)	8 (26.7)	8 (26.7)	3.60	.165
	No	60 (66.7)	16 (53.3)	22 (73.3)	22 (73.3)
Illness related characteristics
Diagnosis	Metastatic tumor	47 (52.2)	15 (50.0)	18 (60.0)	14 (46.7)	8.20^†	.614
	Meningioma	18 (20.0)	5 (16.7)	7 (23.4)	6 (20.0)
	Acoustic neuroma	7 (7.8)	2 (6.7)	1 (3.3)	4 (13.3)
	Artero Venous	5 (5.6)	3 (10.0)	2 (6.7)	0 (0.0)
	Malformation
	Hemangioma	4 (4.4)	1 (3.3)	1 (3.3)	2 (6.7)
	Pituitary adenoma	9 (10.0)	4 (13.3)	1 (3.3)	4 (13.3)
Status of companion disease	Yes	32 (35.6)	19 (63.3)	19 (63.3)	20 (66.7)	0.10	.953
	No	58 (64.4)	11 (36.7)	11 (36.7)	10 (33.3)
Subjective health status	Very poor	6 (6.7)	1 (3.3)	2 (6.7)	3 (10.0)	6.16^†	.410
	Poor	38 (42.2)	11 (36.7)	14 (46.7)	13 (43.3)
	Ordinary	38 (42.2)	16 (53.3)	9 (30.0)	13 (43.3)
	Healthy	8 (8.9)	2 (6.7)	5 (16.6)	1 (3.4)
Waiting time before Surgery	Hospitalization≥ 1day	19 (21.1)	8 (26.7)	4 (13.4)	7 (23.3)	6.77^†	.118
	Hospialization< 1day	5 (5.6)	4 (13.3)	1 (3.3)	0 (0.0)
	Hospitalization within 1hr	66 (73.3)	18 (60.0)	25 (83.3)	23 (76.7)
Guardian company before	Yes	82 (91.1)	27 (90.0)	27 (90.0)	28 (93.3)	0.41	>.999
Surgery	No	8 (8.9)	3 (10.0)	3 (10.0)	2 (6.7)
Past Craniotomy history	Yes	18 (20.0)	5 (16.7)	6 (20.0)	7 (23.3)	0.42	.812
	No	72 (80.0)	25 (83.3)	24 (80.0)	23 (76.7)
History of GKS	Yes	16 (17.8)	7 (23.3)	5 (16.7)	4 (13.3)	1.06	.587
	No	74 (82.2)	23 (76.7)	25 (83.3)	26 (86.7)
Number of GKS	Once	9 (60.0)	4 (57.1)	3 (75.0)	2 (50.0)	2.22^†	>.999
	Twice	6 (40.0)	3 (42.9)	1 (25.0)	2 (50.0)
History of other OP	Yes	46 (51.1)	14 (46.7)	15 (50.0)	17 (56.7)	0.62	.733
	No	44 (48.9)	16 (53.3)	15 (50.0)	13 (43.3)
NRS after iv injection (score)		2.70 (1.3)	2.87 (1.4)	2.42 (1.0)	2.84 (1.6)	0.90	.412
State anxiety (score)		45.01 (11.1)	42.27 (11.2)	45.53 (11.2)	47.23 (10.7)	1.57	.214
Dependent variable
SBP before infiltration anesthesia (mmHg)		132.69 (18.3)	130.03 (17.3)	134.17 (19.8)	133.87 (18.1)	0.47	.626
DBP before infiltration anestesia (mmHg)		84.74 (10.8)	83.30 (11.8)	85.40 (11.1)	85.53 (9.6)	0.40	.672
PR before infiltration anesthesia (Frequency per minute)		97.18 (13.6)	95.60 (14.8)	99.10 (15.2)	96.83 (10.5)	0.51	.605

DBP=Diastolic blood pressure; EMLA=Eutectic Mixture of Local Anesthetic; GKS=Gamma knife surgery; OP=Operation; PR=Pulse rate; SBP=Systolic blood pressure; SD=Standard deviation.

^†Fisher’s exact test.

Table 2.

Test of Differences about Pain Response after Infiltration Anesthesia according to Pain Relieving Intervention (N=90)

Categories	Pain relieving intervention	Pain after iv injection	Pain after infiltration anesthesia	Adjusted pain after infiltration anesthesia	Source	F	p	Scheffe	partia η²	Effect size f
		Mean (SD)	Mean (SD)	Mean (SD)
Subjective	EMLA cream plus 10.0%	2.67 (1.30)	4.97 (1.50)	4.97 (0.35)	T1	4.73	.032	2<1<3
pain by NRS	Lidocaine spray group
(score)	(n=30)¹
	EMLA cream plus	2.37 (0.93)	4.10 (1.16)	4.10 (0.25)	Effectivness of	13.56	<.001		.24	0.56
	Vapocoolant spray group				pain relieving
	(n=30)²				intervention
	EMLA cream only group	2.77 (1.45)	6.17 (1.74)	6.12 (0.40)
	(n=30)³
	Total (n=90)	2.60 (1.24)	5.08 (1.70)	5.08 (0.92)
Objective pain	EMLA cream plus 10.0%	2.67 (1.30)	0.34 (0.41)	0.35 (0.08)	T1	0.15	.703	2<1<3
by Galvanic	Lidocaine spray group
Skin	(n=30)¹
Response	EMLA cream plus Vapo-	2.37 (0.93)	0.13 (0.15)	0.13 (0.08)	Effectivness of	14.43	<.001		.25	0.58
(μS)	coolant spray group				pain relieving
	(n=30)²				intervention
	EMLA cream only group	2.77 (1.45)	0.72 (0.60)	0.73 (0.08)
	(n=30)³
	Total (n=90)	2.60 (1.24)	0.40 (0.49)	0.40 (0.24)

EMLA=Eutetic mixture of local anesthetics; NRS=Numeric rating scale; SD=Standard deviation. T1=Pain at intravenous injection.

Table 3.

Test of Differences about Change of Physiological Response before and after Experimental Intervention (N=90)

Categories	Pain relieving intervention	Before	After	Before - After	F	p	Scheffe	Effect size f
		Mean (SD)	Mean (SD)	Mean (SD)
Systolic Blood	EMLA cream plus 10.0% Lidocaine	130.03 (17.29)	145.87 (20.98)	15.84 (11.20)	4.77	.011	2<1,3	2.98
pressure	spray group (n=30)¹
(mmHg)	EMLA cream plus Vapocoolant spray	134.17 (19.75)	144.13 (22.25)	9.96 (7.43)
	group (n=30)²
	EMLA cream only group (n=30)³	133.87 (18.10)	151.07 (19.99)	17.20 (9.91)
	Total (n=90)	132.69 (18.30)	147.02 (21.06)	14.33 (1.05)
Diastolic blood	EMLA cream plus 10.0% Lidocaine	83.30 (11.80)	91.30 (12.25)	8.00 (7.20)	1.51	.227		0.18
pressure	spray group (n=30)¹
(mmHg)	EMLA cream plus Vapocoolant spray	85.40 (11.08)	90.17 (12.35)	4.77 (7.28)
	group (n=30)²
	EMLA cream only group (n=30)³	85.53 (9.59)	91.57 (11.30)	6.04 (7.30)
	Total (n=90)	84.74 (10.79)	91.01 (11.85)	6.27 (7.30)
Pulse rate	EMLA cream plus 10.0% Lidocaine	95.60 (14.75)	107.50 (15.85)	11.90 (10.16)	4.78	.011	2<1,3	0.31
(Frequency per	spray group (n=30)¹
minute)	EMLA cream plus Vapocoolant spray	99.10 (15.24)	105.53 (13.87)	6.43 (8.56)
	group (n=30)²
	EMLA cream only group (n=30)³	96.83 (10.51)	110.70 (12.98)	13.87 (10.13)
	Total (n=90)	97.18 (13.59)	107.91 (14.28)	10.73 (10.04)

EMLA=Eutetic mixture of local anesthetics; SD=Standard Deviation.

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