冰敷對表淺撕裂傷注射局部麻醉時降低疼痛之成效The assessment of ice pack effect in pain reduction during local anesthetic injections for superficial lacerations.

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2021-02-02 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

劉靜芳* 林麗英 黃雅惠 陳韻筑 李季衡

實證知識類別

B 類:實證健康照護應用

PICO

治療/預防性問題

治療/介入措施

急診醫學 Emergency Medicine

科別

  • 臨床指引/實證照護成效 Clinical Guidelines/Evidence Based Outcomes

中文關鍵詞

表淺撕裂傷、局部麻醉、冰敷、疼痛

英文關鍵詞

Superficial lacerations Local anesthetic injection Ice Pain.

機構名稱

高雄榮民總醫院

申請單位

護理部

中文摘要

形成臨床提問:
在傷口縫合前注射局部麻醉藥是為了達到止痛效果,但當針頭注射時卻引發病人劇烈疼痛,以致病人畏懼治療,且護理師常聽到病人抱怨打麻醉針比受傷時還要感到劇痛;在臨床上冰敷簡便、易取得且接受度高,因而想以實證方法探討冰敷對表淺撕裂傷注射局部麻醉時降低疼痛之成效。
文獻搜尋的方法與分析:
依據實證護理步驟,以P、I、O關鍵字,包含自然語言與MeSH term,使用布林邏輯「OR」與「AND」,運用檢索策略6S,設定Filter提升搜尋效率,及Create Alert隨時追蹤最新文獻,於UpToDate、DynaMed、PubMed、Cochrane Library、Trip Database、Airiti Library資料庫進行文獻搜尋,納入標準為1.不限制文獻年限、型態與語言;2.對象為表淺撕裂傷需執行局部麻醉;3.介入措施為冰敷,最終擷取3篇隨機對照試驗,最符合臨床問題。
文獻的品質評讀:
文獻評讀工具採用Critical Appraisal Skills Programme (CASP) 2020年版「Randomised Controlled Trial Checklist」,評讀證據可信性、方法合理性、結果重要性與臨床適用性,再以2019年2.0版考科藍偏誤風險評比工具,針對研究設計、執行過程偏誤風險做進一步評讀,三篇文獻結果皆為「低風險」,證據等級採用英國牛津大學實證醫學中心2011年所建議之臨床研究證據分級表,三篇等級皆為Level 2,研究結果顯示冰敷能顯著降低局部麻醉注射之疼痛程度。
證據之臨床應用:
運用實證知識轉譯七步驟實施方案,同時進行結果分析。方案設計屬隨機控制試驗,資料收集者盲,收案時間自2020年4月25日至6月6日,地點南部某醫學中心急診外傷科,納入對象為表皮與真皮層撕裂傷需局部麻醉者,介入措施為冰敷,評量工具使用0-10分數字疼痛量表。
成效評值:
運用統計分析,探討冰敷對表淺撕裂傷注射局部麻醉時降低疼痛之成效。收案人數共60名,隨機分派冰敷組30人、無冰敷組30人;在基本資料與傷口種類無達顯著差異(p>.05),具有同質性;在局部麻醉前冰敷與否,兩組局部麻醉當下疼痛指數相比較,p=.001,達顯著差異,結果顯示冰敷可顯著降低局部麻醉注射疼痛指數。
結論與建議:
疼痛是種主觀感受,若個體未獲得良好疼痛控制,將會連帶影響身心靈各個層面,雖然冰敷只是簡單且平淡無奇的介入措施,但對於每天眾多需執行局部麻醉傷口縫合病人而言,降低疼痛的同時,也能降低病人對局部麻醉注射的恐懼感、增加醫療處置配合度與就醫滿意度。由於此篇僅收案頭部與上肢撕裂傷病人做分析比較,不同部位疼痛感受程度可能不同,建議未來可持續實施臨床應用,做進一步評估分析,讓需局部麻醉傷口縫合病人得以受惠,提升整體照護品質。

英文摘要

Ask an answerable question (PICO):
In most cases, local anesthetic agents are used for reducing pain during primary repair, but it often causes severe pain or discomfort during subcutaneous injection, which masks patients afraid of treatment. Nurses often hear patients complain that anesthesia injections are more painful than when they’re injured. Ice-pack application is easy, affordable, and well received by patients. Therefore, we want to use an empirical method to explore the effectiveness of ice pack in pain reduction during local anesthetic injections for superficial lacerations.
The Method and Analysis of Literature Review:
Based on empirical nursing steps, use P, I, O keywords, including natural language and MeSH term, use Boolean logic "OR" and "AND", use search strategy 6S, set Filter to improve search efficiency, and Create Alert to keep track of the latest updates at any time. Documents were searched in the databases of UpToDate, DynaMed, PubMed, Cochrane Library, Trip Database, Airiti Library. The inclusion criteria were 1. No limitation on document age, type and language; 2. Subjects for superficial lacerations need to be implemented local anesthesia; 3. The interventional measure is ice pack, and finally 3 randomized controlled trials were selected, which best meets the clinical problem.
Critical Appraisal:
The literature review tool adopts the "Randomised Controlled Trial Checklist" of the Critical Appraisal Skills Programme (CASP) 2020 edition to assess the validity of the evidence, methodologically sound, the importance of the results and the clinical applicability. Using the 2019 version 2.0 of Cochrane’s Risk of Bias Tool, further evaluation is made on the risk of error in the research design and implementation process. The results of three literatures are "low risk". The level of evidence adopts the clinical research evidence grading table recommended by the Centre for Evidence Medicine, Oxford University, UK in 2011. Three articles are Level 2. Research results show that ice pack can significantly reduce the pain of local anesthetic injection.
Clinical Application of Evidence:
Use empirical knowledge to translate the seven-step implementation plan and analyze the results. The design of the scheme is a randomized controlled trial. The data collectors are blind. The acceptance time is from April 25 to June 6, 2020. It is located in the Emergency Traumatology Department of a Medical Center in the south. The subjects included are epidermal and dermal lacerations requiring local anesthesia. The intervention is ice pack. Pain scores were measured using a numerical rating scale.
Evaluation of Effectiveness:
Use statistical analysis to explore the effect of suturing superficial lacerations with ice packing before local anesthesia injection on reducing pain. Sixty subjects were enrolled in the study, 30 in each group. Subjects who presented with superficial lacerations were randomly assigned to 2 groups, the first group received ice packing prior to injection and the second didn’t. There were no statistical differences between the 2 groups in terms of baseline preoperative and wound characteristics (p>.05). The pain sores in the cryotherapy group were significantly lower after the procedure (p=.001). Ice packing before subcutaneous local anesthetic injections can significantly reduce pain from local anesthetic injections in patients presenting for superficial laceration repair.
Conclusions and Recommendations:
Perception of pain is subjective. If the individual does not obtain good pain control, it will affect all levels of the body, mind, and soul. Although ice packing is a simple and unremarkable intervention, for many patients who need to perform local anesthetic for wound repair everyday, while reducing pain, it can also reduce the patient's fear of local anesthesia injection, increase the degree of medical treatment coordination and satisfaction. Since this article only accepts patients with head and upper extremity lacerations, the degree of pain in different parts may be different. It’s recommended to continue to implement clinical applications in the future and conduct further evaluation and analysis, so that may benefit patients from local anesthesia and suture wounds. Improve the overall quality of care.