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.
