The effect on pain of three different methods of intramuscular injection: A randomized controlled trial

Abstract

This paper is the report of a study to determine the effect on pain of internally rotating the foot, pointing the toes down and/or using the Z-track technique during intramuscular injection and to investigate differences in pain perception related to gender and body mass index. A randomized controlled trial was carried out from September to November 2010 on 75 patients receiving diclofenac sodium intramuscularly at a university hospital in Zonguldak, Turkey. The primary outcome measure collected was pain intensity, measured on a visual analogue scale. Each subject received three injections by the same investigator using three different techniques. The three techniques were randomly allocated, and the subjects were blinded to the injection technique being used. After each injection, another investigator, who had no prior knowledge of which injection technique was used, immediately assessed pain intensity using the visual analogue scale. Research findings demonstrated that the Z-track and internally rotated foot techniques significantly reduced pain intensity during intramuscular injection. Statistically significant differences in pain intensity were observed between the three injection techniques. The results supported the hypothesis that the internally rotated foot and Z-track techniques significantly reduce pain intensity.

Systematic review and meta‐analysis: Physical‐procedural interventions used to reduce pain during intramuscular injections in adults

“…The five RCTs (Barnhill et al, ; Çelik & Khorshid, ; Kara & Yapucu Güneş, ; Rock, ; Yilmaz, Khorshid, et al, ) provided detailed information about the randomization process. These studies had low random sequence generation bias; bias with the other study was unclear (Table ).…”

“…Five studies had a low level of bias related to blinding of outcome assessment (Ağaç & Yapucu Güneş, ; Alavi, ; Kara & Yapucu Güneş, ; Yilmaz, Dikmen, et al, ; Yilmaz, Khorshid, et al, ). The blinding was unclear in two studies (Chung et al, ; Rock, ).…”

“…In this SR, the Z‐technique SMD had a moderate effect in terms of pain relief (Figure ). Kara and Yapucu Güneş () compared the effect of the Z‐technique on the IM injection pain in three different positions. The internally rotated foot and Z‐technique resulted in the patients feeling less pain (Table ).…”

“…In this SR, the Z-technique SMD had a moderate effect in terms of pain relief (Figure 4). Kara and Yapucu Güneş (2016) When the injection site was varied, the overall SMD on pain was moderate. The pain scale SMD in the VG site was large; it was determined to be less than that in the VG-DG site.…”

“…Even with these precautions, some patients feel the pain during the IM injections. Many physical-procedural interventions can be used to prevent pain (Cocoman & Murray, 2008;Kara et al, 2015;Kara & Yapucu Güneş, 2016;Kaya, Salmaslioğlu, Terzi, Turan, & Acunaş, 2015;Larkin, Ashcroft, Elgellaie, & Hickey, 2017). Some of these interventions include acupressure, manual pressure, postinjection massage, the ShotBlocker, the Z-technique, the air-lock technique, and altered injection speed.…”