Which site is more painful in intramuscular injections? The dorsogluteal site or the ventrogluteal site? A case study from Turkey

Abstract

The aim of the study was to examine the effect on pain of medication administered by intramuscular injection to the dorsogluteal and ventrogluteal sites, and to investigate gender and body mass index differences in pain perception between the sites. This clinical trial was performed on 70 adult patients receiving at least two doses of diclofenac sodium intramuscularly in a state hospital in Bursa, Turkey. Two injections were administered to each patient with an interval of 24 hours by the same researcher using two injection sites. The injection sites were randomly allocated. After each injection, the pain felt by patients during the injection was immediately assessed using a visual analog scale by another researcher who had no prior knowledge of which the injection site. Numerical and percentage distribution of sociodemographic data on patients' identification characteristics were calculated. The Wilcoxon signed rank test was used to explore determine the statistical differences in perceived pain intensity between the two injection sites. Differences in the mean pain intensity at the dorsogluteal and ventrogluteal sites by BMI and gender were analysed using the paired t test. The average pain score of patients after injections to the ventrogluteal site was 1.24±1.18, while that for injections to the dorsogluteal site was 1.89±1.49. The difference in average pain scores from injections administered to the two different sites was found to be statistically significant (p<0.05). The results supported the hypothesis that intramuscular injections of diclofenac sodium administered to the ventrogluteal site would feel less painful than those administered to the dorsogluteal site.

Dolor al administrar medicamento por inyección intramuscular: ventroglútea vs dorsoglútea

“…El ensayo clínico aleatorizado de Güneş et al 20 es el estudio que más se acerca a responder la pregunta clínica planteada, ya que incluye los siguientes descriptores definidos: sitios ventroglúteo, dorsoglúteo, dolor y antiinflamatorios (diclofenaco sódico).…”

“…En cuanto a los resultados, la puntuación promedio de la intensidad del dolor percibido en el sitio ventroglúteo fue de 1,24 (DE = 1,18), mientras que en el sitio dorsoglúteo fue de 1,89 (DE = 1,49). Una prueba de los rangos con signo de Wilcoxon mostró una diferencia estadísticamente significativa en la intensidad media entre el sitio dorsoglúteo y el ventroglúteo (Z = -2,34, p = 0,019) 20 . En lo concerniente a la relación con el género, las mujeres y los hombres reportaron significativamente menos dolor con las inyecciones administradas en el sitio ventroglúteo.…”

“…Los autores del estudio concluyen que los resultados demostraron que el dolor en las inyecciones intramusculares de diclofenaco sódico administradas al sitio ventroglúteo fue menor. También se destaca la necesidad de seguir investigando con diferentes medicamentos y con un número mayor de muestra, incluyendo los pacientes con diagnóstico diferente y todos los grupos de índice de masa corporal, para poder generalizar los resultados 20 .…”

Creating a change in the use of ventrogluteal site for intramuscular injection

“…The results of the study conducted by Tuğrul and Denat 2 are also parallel. However, Güneş et al 29 and Moharreri et al 31 found that patients felt less pain with VG site injection when compared to the DG site injection. Coskun et al 24 stated that less pain is experienced in the VG site since there are no major neurovascular structures in the site.…”

“…One of the reasons is the belief that the risk of reaching the bone tissue of the needle is high (26.0%). However, in the literature, 29 it is stated that the VG site is distant from the bone tissue. Masuda et al 30 reported that the injection needle to be used for people with standard body shape would not contact the iliac bone as long as it is <~45 mm.…”