Journal List > J Korean Acad Nurs > v.48(2) > 1003302

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

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.

References

1. Gerosa M, Nicolato A, Foroni R. The role of gamma knife radiosurgery in the treatment of primary and metastatic brain tumors. Current Opinion in Oncology. 2003; 15(3):188–196. https://doi.org/10.1097/00001622-200305000-00002.
crossref
2. Health Insurance Review and Assessment Service. One out of every four was surgeried with Gamma Knife in 2016 [Internet]. Seoul: Health Insurances Review and Assessment Service;c2016. [cited 2015 Nov 26]. Available from:. http://opendata.hira.or.kr/op/opc/olapDiagBhvInfo.do.
3. Baek SY, Choi JY. Associated factors with pin-fixing & pin removal pain among patients undergoing gamma knife radiosurgery. Asian Oncology Nursing. 2012; 12(4):323–330. https://doi.org/10.5388/aon.2012.12.4.323.
4. Choi EK, Ro Y, Park SS, Park KB. The use of EMLA cream reduces the pain of skin puncture associated with caudal block in children. Korean Journal Anesthesiology. 2016; 69(2):149–154. https://doi.org/10.4097/kjae.2016.69.2.149.
crossref
5. Sohn KS, Lee HW, Choi SU, Lim HJ, Yoon SM, Chang SH. The effect of remifentanil on pain during local anesthetic infiltration in moderately sedated plastic surgery patients. Korean Journal of Anesthesiology. 2007; 53(3):318–324. https://doi.org/10.4097/kjae.2007.53.3.318.
crossref
6. Lee YH, Kim NC. The Comparison of effects of 2% lidocaine intradermal injection and 10% lidocaine spray for pain and anxiety relief on arteriovenous fistula puncture in hemodialysis patients. Journal of Korean Clinical Nursing Research. 2007; 13(2):169–177.
7. Hosseini Jahromi SA, Hosseini Valami SM, Hatamian S. Comparison between effect of lidocaine, morphine and ketamine spray on post-tonsillectomy pain in children. Anesthesiology and Pain Medicine. 2012; 2(1):17–21. https://doi.org/10.5812/aapm.4092.
crossref
8. Farion KJ, Splinter KL, Newhook K, Gaboury I, Splinter WM. The effect of vapocoolant spray on pain due to intravenous cannulation in children: A randomized controlled trial. Canadian Medical Association Journal. 2008; 179(1):31–36. https://doi.org/10.1503/cmaj.070874.
crossref
9. Collado-Mesa F, Net JM, Arheart K, Klevos GA, Yepes MM. Application of a topical vapocoolant spray decreases pain at the site of initial intradermal anaesthetic injection during ultrasound-guided breast needle biopsy. Clinical Radiology. 2015; 70(9):938–942. https://doi.org/10.1016/j.crad.2015.04.013.
crossref
10. Rüsch D, Koch T, Seel F, Eberhart L. Vapocoolant spray versus lidocaine infiltration for radial artery cannulation: A prospective, randomized, controlled clinical trial. Journal of Cardiothoracic and Vascular Anesthesia. 2017; 31(1):77–83. https://doi.org/10.1053/j.jvca.2016.06.008.
crossref
11. BIT Druginfo. Main homepage [Internet]. Seoul: BIT Drugin-fo;[cited 2018 Jan 25] Available from:. https://www.druginfo.co.kr/detail/product.aspx?pid=50355.
12. Han SS, Lee SC. Nursing and health statistical analysis. 2nd ed. Seoul: Fornurse;2011. p. 43.
13. Jensen MP, Karoly P, O’Riordan EF, Bland F Jr, Burns RS. The subjective experience of acute pain. An assessment of the utility of 10 indices. The Clinical Journal of Pain. 1989; 5(2):153–160. https://doi.org/10.1097/00002508-198906000-00005.
crossref
14. Shaver BA Jr, Brusilow SW, Cooke RE. Origin of the galvanic skin response. Experimental Biology and Medicine. 1962; 110(3):559–564. https://doi.org/10.3181/00379727-110-27579.
crossref
15. Kim JT, Shin DK. A study based on the standardization of the STAI for Korea. The New Medical Journal. 1978; 21(11):69–75.
16. Vitasari P, Wahab MNA, Herawan T, Othman A. Re-test of State Trait Anxiety Inventory (STAI) among engineering students in Malaysia: Reliability and validity tests. Procedia-Social and Behavioral Sciences. 2011; 15(2011):3843–3848. https://doi.org/10.1016/j.sbspro.2011.04.383.
crossref
17. Hahn DW, Lee CH, Chon KK. Korean adaption of Spielberger’s STAI (K-STAI). Korean Journal of Health Psychology. 1996; 1(1):1–14.
18. Soriano D, Ajaj S, Chuong T, Deval B, Fauconnier A, Daraï E. Lidocaine spray and outpatient hysteroscopy: Randomized placebo controlled trial. Obstetrics & Gynecology. 2000; 96(5):661–664. https://doi.org/10.1097/00006250-200011000-00004.
19. World Health Organization. Cancer pain relief: With a guide to opioid availability. 2nd ed. Geneva: WHO;1996. p. 16–17.
20. Kim YS, Park HR. Effects of topical anesthetic cream on pain at venipuncture in children. Child Health Nursing Research. 2014; 20(3):142–148. https://doi.org/10.4094/chnr.2014.20.3.142.
crossref
21. Baba M, Watahiki Y, Matsunaga M, Takebe K. Sympathetic skin response in healthy man. Electromyography Clinical Neurophysiology. 1988; 28(5):277–283.
22. Maxwell C. Sensitivity and accuracy of the visual analogue scale: A psycho-physical classroom experiment. British Journal of Clinical Pharmacology. 1978; 6(1):15–24. https://doi.org/10.1111/j.1365-2125.1978.tb01676.x.
23. Chesterton LS, Foster NE, Ross L. Skin temperature response to cryotherapy. Archives of Physical Medicine & Rehabilitation. 2002; 83(4):543–549. https://doi.org/10.1053/apmr.2002.30926.
crossref
24. Kose O, Saylan S, Ediz N, Yigit S. Effects of topical alkane vapocoolant spray on pain intensity prior to digital nerve block for ingrown nail surgery. Foot & Ankle Specialist. 2010; 3(2):73–75. https://doi.org/10.1177/1938640010363172.
crossref
25. Moon YE, Kim SH, Choi WH. Comparison of the effects of vapocoolant spray and topical anesthetic cream on pain during needle electromyography in the medial gastrocnemius. Archives of Physical Medicine and Rehabilitation. 2013; 94(5):919–924. https://doi.org/10.1016/j.apmr.2012.12.008.
crossref
26. Waterhouse MR, Liu DR, Wang VJ. Cryotherapeutic topical analgesics for pediatric intravenous catheter placement: Ice versus vapocoolant spray. Pediatric Emergency Care. 2013; 29(1):8–12. https://doi.org/10.1097/PEC.0b013e31827b214b.
27. Choi SH, Baek KH, Lee JY, Lim HB, Kim HJ, Kim YS, et al. The effect of warm and ice application for pain control caused by arteriovenous fistula needling under hemodialysis. Journal of Korean Clinical Nursing Research. 2006; 12(1):179–189.
28. Choi EK, Jung JM, Sin JB. Pain reducing effect of vapocoolant spray during injection and heel stick procedure in neonates. Korean Journal of Pediatrics. 2008; 51(5):481–486. https://doi.org/10.3345/kjp.2008.51.5.481.
29. Mace SE. Prospective, randomized, double-blind controlled trial comparing vapocoolant spray vs spray in adults undergoing venipuncture. The American Journal of Emergency Medicine. 2016; 34(5):798–804. https://doi.org/10.1016/j.ajem.2016.01.002.
30. Kunesch E, Schmidt R, Nordin M, Wallin U, Hagbarth KE. Peripheral neural correlates of cutaneous anaesthesia induced by skin cooling in man. Acta Physiologica. 1987; 129(2):247–257. https://doi.org/10.1111/j.1748-1716.1987.tb08065.x.
crossref

Figure 1.
Randomized controlled trial flow diagram.
jkan-48-221f1.tif
Figure 2.
Flow of the study.
jkan-48-221f2.tif
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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