What are the management options for pain at the injection site?

From the Guidelines

Pain at the injection site can be effectively managed with topical lidocaine-prilocaine emulsion, such as EMLA cream, applied 30-60 minutes before injection, as it has been shown to decrease pain in infants and children 1. The management of pain at the injection site involves a combination of topical anesthetics, comfort measures, and distraction techniques.

• Topical lidocaine-prilocaine emulsion, such as EMLA cream, can be applied 30-60 minutes before injection to decrease pain in infants and children 1.
• Acetaminophen or ibuprofen can be used to reduce discomfort and fever associated with vaccination, but their use should be cautious due to potential interactions with lidocaine-prilocaine cream 1.
• Vapocoolant spray can also be used to reduce short-term pain associated with injections, and its effectiveness is comparable to lidocaine-prilocaine cream 1.
• Administering sweet-tasting fluid orally immediately before injection can result in a calming or analgesic effect in certain infants 1.
• More recent studies have explored the use of sodium bicarbonate to buffer local anesthetics, which has been shown to decrease patient pain during drug delivery via subcutaneous or intradermal infiltration 1. However, the most recent and highest quality study on this topic is from 2016, which recommends the use of buffered local anesthetics to decrease injection pain 1.
• The study found that the addition of sodium bicarbonate to local anesthetic decreased patient pain during drug delivery, with approximately 2 out of 3 patients noting a 20-40% decrease in injection pain 1. It is essential to note that the evidence from study 1 is not directly relevant to the management of pain at the injection site, as it focuses on the treatment of pulmonary arterial hypertension. Therefore, the most effective management option for pain at the injection site is the use of topical lidocaine-prilocaine emulsion, such as EMLA cream, applied 30-60 minutes before injection, or the use of buffered local anesthetics, as recommended by the most recent and highest quality study 1.

From the Research

Management Options for Pain at the Injection Site

• The management of pain at the injection site can be achieved through various methods, including changing injection techniques, patient education, and training 2.
• The use of cold air has been shown to be effective in reducing needle-injection pain, with studies demonstrating a significant reduction in pain scores when cold air is used 3, 4.
• Compression and cold application have also been found to be effective in reducing pain and bruising at the injection site, with one study showing that compression resulted in lower pain scores and smaller bruising sizes compared to cold application and control groups 5.
• Physical interventions and injection techniques, such as stroking the skin or applying pressure close to the injection site, can also help reduce pain during vaccine injection in children 6.
• The order of vaccine injection, with the least painful vaccine injected first, and the use of rapid intramuscular injection without aspiration, can also help decrease pain during immunization 6.
• Other methods, such as the use of cold spray, have been compared to other interventions, such as ShotBlocker, and found to be effective in reducing pain caused by intramuscular injection 4.

Injection Techniques and Patient Education

• Changing injection techniques, such as using a rapid intramuscular injection without aspiration, can help reduce pain during injection 6.
• Patient education and training can also help prevent local reactions to subcutaneously administered biological agents, with almost all local reactions able to be prevented through proper injection techniques and patient education 2.
• The use of cold air, compression, and cold application can be incorporated into clinical practice to help reduce pain and bruising at the injection site 3, 5, 4.

Comparison of Methods

• Studies have compared the effects of different methods, such as cold spray and ShotBlocker, on pain reduction during intramuscular injection, with cold spray found to be effective in reducing pain 4.
• The comparison of different formulations of the same vaccine has also been studied, with some formulations found to cause less pain than others 6.
• The use of physical interventions and injection techniques has been found to be effective in reducing pain during vaccine injection in children, with methods such as stroking the skin or applying pressure close to the injection site found to be beneficial 6.