Effect of local refrigeration prior to venipuncture on pain related responses in school age children

Introduction: Painful medical procedures are the major sources of distress among children; and for those with chronic diseases, the procedure-related pain can be worse than that of the illness itself. Objective: The purpose of the study was to determine the effect of local refrigeration prior to venipuncture on pain-related responses in school age children. Design: Quasi-experimental study. Setting: This study was undertaken in a paediatric emergency ward of a paediatric centre. Subjects: The subjects were 80 children 6 to 12 years of age selected by purposive sampling after being referred to the paediatric emergency ward. Interventions: Two groups were chosen for the study: the test and control groups, in order to test the effect of local coldness in reducing the pain of venipuncture. In the test group, the injection site was refrigerated for three minutes using an ice bag. In the control group, the procedure was performed according to usual routine. Physiological responses (ie. blood pressure, pulse, and respiration), behavioural responses (using the Children's Hospital of Eastern Ontario Pain Scale: CHEOPS), and subjective responses (or intensity of pain using the Oucher scale) were measured in the two groups. A non-invasive (electronic) sphygmomanometer was used before and 5 minutes after the procedure to measure the physiological responses. The measurement of behavioral responses by CHEOPS was done at two time points (during the procedure and 5 minutes after the procedure), measuring six areas of behaviour: cry, facial expressions, child verbal, torso, touch and leg movement in reaction to painful stimulation. Finally, the subjective responses were measured at 5 minutes after the procedure. Main outcome measures: In this study the main outcome measures were: range of physiologic responses, and scores of behavioral and subjective responses. The study hypothesised there would be a lower score in the test group than the control group in behavioural and subjective responses and a lower range in physiologic responses. Results: Results showed no significant difference between the two groups for physiological responses (before and after procedure). However behavioural responses during and after the procedure (p=0.0011), and subjective responses after the procedure (p=0.0097) were significantly lower (ie. the test group had lower scores in behavioural and subjective responses compared to the control group. Conclusion: The results of this study suggest that th