scholarly journals The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250883
Author(s):  
Oluseyi Ayinde ◽  
Rachel S. Hayward ◽  
Jonathan D. C. Ross
Keyword(s):  
Systematic Review ◽  
Injection Site ◽  
Intramuscular Injection ◽  
Meta Analysis ◽  
Injection Pain ◽  
Injection Technique ◽  
Local Pressure ◽  
Needle Technique ◽  
Pain Intervention ◽  
Manual Pressure

Aim To review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults. Methods The review protocol was registered on PROSPERO (CRD42019136097). MEDLINE, EMBASE, British Nursing Index and CINAHL were searched up to June 2020. Included studies were appraised and a meta-analysis, where appropriate, was conducted with a random effects model and test for heterogeneity. Standardised mean difference (SMD) with a 95% confidence interval in reported injection pain (intervention cf. control) was reported. Results 29 studies were included in the systematic review and 20 studies in the meta-analysis. 13 IMI techniques were identified. 10 studies applied local pressure to the injection site. Of these, applying manual pressure (4 studies, SMD = -0.85[-1.36,-0.33]) and Helfer (rhythmic) tapping (3 studies, SMD = -2.95[-5.51,-0.39]) to the injection site reduced injection pain, whereas the use of a plastic device to apply local pressure to the skin (ShotBlocker) did not significantly reduce pain (2 studies, SMD = -0.51[-1.58,0.56]). Acupressure techniques which mostly involved applying sustained pressure followed by intermittent pressure (tapping) to acupressure points local to the injection site reduced pain (4 studies: SMD = -1.62[-2.80,-0.44]), as did injections to the ventrogluteal site compared to the dorsogluteal site (2 studies, SMD = -0.43[-0.81,-0.06]). There was insufficient evidence on the benefits of the ‘Z track technique’ (2 studies, SMD = -0.20[-0.41,0.01]) and the cold needle technique (2 studies, SMD = -0.73[-1.83,0.37]) on injection pain. The effect of changing the needle after drawing up the injectate on injection pain was conflicting and warming the injectate did not reduce pain. Limitations included considerable heterogeneity, poor reporting of randomisation, and possible bias in outcome measures from unblinding of assessors or participants. Conclusions Manual pressure or rhythmic tapping over the injection site and applying local pressure around the injection site reduced IMI pain. However, there was very high unexplained heterogeneity between studies and risk of significant bias within small studies.

scholarly journals Efficacy of injection technique education in diabetes with lipohypertrophy: a systematic review and meta-analysis protocol v2 (protocols.io.btiinkce)

protocols.io ◽  
2021 ◽  
Author(s):  
Masahiro Ichikawa ◽  
Tomoaki not provided ◽  
Yasushi Tsujimoto ◽  
Keisuke not provided ◽  
Tadashi Yamakawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Injection Technique ◽  
Analysis Protocol

scholarly journals Efficacy of injection technique education in diabetes with lipohypertrophy: a systematic review and meta-analysis protocol v1 (protocols.io.btb5niq6)

protocols.io ◽  
2021 ◽  
Author(s):  
Masahiro Ichikawa ◽  
Tomoaki not provided ◽  
Yasushi Tsujimoto ◽  
Keisuke not provided ◽  
Tadashi Yamakawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Injection Technique ◽  
Analysis Protocol

Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis

2020 ◽  
Author(s):  
Paul Guedeney ◽  
Sabato Sorrentino ◽  
Gennaro Giustino ◽  
Celine Chapelle ◽  
Silvy Laporte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Injection Site ◽  
Meta Analysis ◽  
Injection Site Reaction ◽  
Indirect Comparison ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Efficacy And Safety ◽  
Site Reaction ◽  
Increased Risk

Abstract Aims Although alirocumab and evolocumab have both been associated with improved outcomes in patients with dyslipidaemia or established atherosclerotic cardiovascular disease, data on their respective performances are scarce. This study aimed at providing an indirect comparison of the efficacy and safety of alirocumab vs. evolocumab. Methods and results We conducted a systematic review and network meta-analysis of randomized trials comparing alirocumab or evolocumab to placebo with consistent background lipid-lowering therapy up to November 2018. We estimated the relative risk (RR) and the 95% confidence intervals (CIs) using fixed-effect model in a frequentist pairwise and network meta-analytic approach. A total of 30 trials, enrolling 59 026 patients were included. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. Compared with evolocumab, alirocumab was associated with a significant reduction in all-cause death (RR 0.80, 95% CI 0.66–0.97) but not in cardiovascular death (RR 0.83, 95% CI 0.65–1.05). This study did not find any significant differences in myocardial infarction (RR 1.15, 95% CI 0.99–1.34), stroke (RR 0.96, 95% CI 0.71–1.28), or coronary revascularization (RR 1.13, 95% CI 0.99–1.29) between the two agents. Alirocumab was associated with a 27% increased risk of injection site reaction compared to evolocumab; however, no significant differences were found in terms of treatment discontinuations, systemic allergic reaction, neurocognitive events, ophthalmologic events, or new-onset of or worsening of pre-existing diabetes. Conclusion Alirocumab and evolocumab share a similar safety profile except for injection site reaction. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to the heterogeneity of the studied populations treated with the two drugs.

scholarly journals Efficacy and Safety of CGRP Monoclonal Antibodies for the Prevention of Migraine Compared with Placebo: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Xiaojing Yi ◽  
Yun Chen ◽  
Kun Chen ◽  
Mo Liu ◽  
Jiale Yi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Monoclonal Antibodies ◽  
Adverse Events ◽  
Injection Site ◽  
Response Rate ◽  
Meta Analysis ◽  
Upper Respiratory Tract ◽  
Efficacy And Safety ◽  
Upper Respiratory ◽  
Secondary Outcomes

Abstract Background: Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are a novel class of drugs for migraine that includes erenumab, fremanezumab, galcanezumab and eptinezumab. In clinical trials, CGRP mAbs have been reported to show good efficacy in the prevention of episodic migraines or chronic migraines. Our aim was to evaluate the efficacy and safety of CGRP monoclonal antibodies in this study.Methods: We systematically searched for randomized controlled trials in the PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases. The primary outcome was overall mean change from baseline to end of treatment in the number of monthly migraine headache days (MMHDs). The secondary outcomes included 50% response rate, in the number of monthly headache days (MHDs), in the number of monthly headache hours (MHHs), and in the number of monthly acute migraine-specific medication days (MSMDs). The safety outcomes were evaluated in terms of reported adverse events. Results: Eighteen studies including 11,099 patients were included in the meta-analysis. The meta-analysis showed that CGRP mAbs exhibited a significant benefit in reducing the number of MMHDs compared to placebo (Episodic migraine: Std. MD -0.42, 95% CI -0.47 to -0.36; Chronic migraine: Std. MD -0.28, 95% CI -0.35 to -0.21). Similarly, CGRP mAbs were superior to placebo in the secondary outcomes of 50% response rate, MHDs, MHHs, and MSMDs. With respect to safety, serious adverse events and withdrawal due to adverse events were not significantly associated with CGRP mAbs. Fremanezumab was associated with a significantly higher incidence of any adverse event compared with placebo (RR 1.10, 95% CI 1.03 to 1.17). Galcanezumab was associated with significantly higher treatment-emergent adverse events compared with placebo (RR 1.11, 95% CI 1.04 to 1.17). Constipation and injection site pain were significantly higher with erenumab than placebo. Injection site erythema and injection site induration were significantly higher with fremanezumab than placebo. Upper respiratory tract infection, injection site erythema, injection site pruritus and injection site reaction were significantly higher with galcanezumab than placebo. Conclusions: This study confirms that CGRP mAbs are effective as preventive treatments for episodic migraines and chronic migraines. Adverse reactions at the injection site were associated with erenumab, fremanezumab and galcanezumab therapy. Constipation was more common with erenumab. The risk of upper respiratory tract infection was higher with galcanezumab.Systematic review registration: Our PROSPERO protocol registration number: CRD42019125928. Registered 26 November 2019.

Efficacy and safety of figure-of-eight suture versus manual pressure for venous access closure: a systematic review and meta-analysis

2019 ◽  
Vol 57 (3) ◽  
pp. 379-385 ◽  
Author(s):  
Varunsiri Atti ◽  
Mohit K. Turagam ◽  
Jalaj Garg ◽  
Ahmad Alratroot ◽  
George S. Abela ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Venous Access ◽  
Efficacy And Safety ◽  
Manual Pressure
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