Utilization of local pressure devices in pain management during injections: scoping review

Moura, Jefferson Wildes da Silva; Bitencourt, Aline de Souza; Silva, Thiago Lopes; Carmo, Andréia Cristina Feitosa do; Santos, Luciano Marques dos; Rocha, Patrícia Kuerten

doi:10.1590/0034-7167-2023-0399

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Rev. Bras. Enferm. 77 (3) • 2024 • https://doi.org/10.1590/0034-7167-2023-0399 copy

Utilization of local pressure devices in pain management during injections: scoping review

Uso de dispositivos de presión local en el manejo del dolor durante las inyecciones: revisión de alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to map scientific evidence regarding the use of local pressure devices in pain relief during injection procedures in patients.

Methods:

scoping review, following the recommendations of the JBI Manual for Evidence Synthesis and PRISMA-ScR, with searches conducted in the PubMed, EMBASE, CINAHL, LILACS, and PsycINFO databases, without temporal restrictions and with a cutoff date of March 2023.

Results:

a total of 1,514 studies were identified, with 20 articles included in the final sample. The ShotBlocker^® device was utilized during subcutaneous and intramuscular injections in children and adults, proving beneficial in reducing pain, anxiety, and fear associated with the procedure.

Final considerations:

the ShotBlocker^® is a low-cost, easy-to-use device that can enhance nursing clinical practice during painful procedures. However, studies involving the Brazilian Pikluc^® device are scarce. Further research involving both local pressure devices is recommended.

Descriptors:
Equipment and Supplies; Injections; Pain; Nursing Care; Nursing

Database	Search Strategy
PubMed	((“analgesia”[MeSH Terms] OR “analgesia”[All Fields] OR “analgesias”[All Fields] OR “pain relief”[Text Word] OR (“pain”[MeSH Terms] OR “pain”[All Fields]) OR (“anxiety”[MeSH Terms] OR “anxiety”[All Fields] OR “anxieties”[All Fields] OR “anxiety s”[All Fields]) OR (“fear”[MeSH Terms] OR “fear”[All Fields])) AND (equipment and supplies [tw] OR “ShotBlocker”[All Fields] OR “equipment design”[Text Word] OR “device”[Title] OR “Design”[Title])) AND (“inject”[All Fields] OR “injectability”[All Fields] OR “injectant”[All Fields] OR “injectants”[All Fields] OR “injectate”[All Fields] OR “injectates”[All Fields] OR “injected”[All Fields] OR “injectible”[All Fields] OR “injectibles”[All Fields] OR “injecting”[All Fields] OR “injections”[MeSH Terms] OR “injections”[All Fields] OR “injectable”[All Fields] OR “injectables”[All Fields] OR “injection”[All Fields] OR “injects”[All Fields] OR (“needle s”[All Fields] OR “needled”[All Fields] OR “needles”[MeSH Terms] OR “needles”[All Fields] OR “needle”[All Fields] OR “needling”[All Fields] OR “needlings”[All Fields]))
EMBASE	(‘equipment design’/exp OR ‘equipment design’ OR ‘product design’/exp OR ‘product design’ OR ‘shotblocker’) AND (‘injection’/exp OR ‘blood vessel injection’ OR ‘gluteal injection’ OR ‘injection’ OR ‘injection solution’ OR ‘injections’ OR ‘percutaneous injection’ OR ‘needle’/exp) AND (‘fear’/exp OR ‘fear’ OR ‘anxiety’/exp OR ‘analgesia’/exp OR ‘analgesia’ OR ‘analgesia’ OR ‘pain management’ OR ‘pain relief’ OR ‘sequential analgetic analgesia’ OR ‘surgical analgesia’ OR ‘pain’/exp OR ‘acute pain’ OR ‘deep pain’ OR ‘lightning pain’ OR ‘nocturnal pain’ OR ‘pain’ OR ‘pain response’ OR ‘pain syndrome’ OR ‘treatment related pain’)
CINAHL LILACS PSYCINFO	(analgesia OR pain relief OR pain OR anxiety OR fear) AND (injection OR needle) AND (equipment design OR devices OR design OR equipment and supplies OR shotblocker)

ID	Authorship Year Country	Objective	Study design Sample Setting Route of administration	Main results	Level of evidence
S1	Cobb et al.(²³23 Cobb JE, Cohen LL. A randomized controlled trial of the Shotblocker for children’s immunization distress. Clin J Pain. 2009;25(9):790-6. https://doi.org/10.1097/AJP.0b013e3181af1324 https://doi.org/10.1097/AJP.0b013e3181af... ) 2009 United States of America	To examine the effectiveness of ShotBlocker^®, a physical intervention designed to reduce injection pain in children.	Study type: Randomized Controlled Trial. Sample: 89 children, aged 4 to 12 years, and their respective parents. Setting: Pediatric clinic. Route of administration: Subcutaneous and intramuscular.	There was no evidence of ShotBlocker^® effectiveness in reducing pain associated with common childhood immunizations. Likewise, it was not effective in reducing childhood anxiety.	II
S2	Drago et al.(²⁴24 Drago LA, Singh SB, Douglass-Bright A, Yiadom MY, Baumann BM. Efficacy of ShotBlocker in reducing pediatric pain associated with intramuscular injections. Am J Emerg Med. 2009;27(5):536-43. https://doi.org/10.1016/j.ajem.2008.04.011 https://doi.org/10.1016/j.ajem.2008.04.0... ) 2009 United States of America	To determine the efficacy of ShotBlocker^® in reducing pediatric pain during intramuscular injections.	Study type: Randomized Controlled Prospective Study. Sample: 165 children, aged 2 months to 17 years. Setting: Pediatric outpatient clinic of a University Hospital. Route of administration: Intramuscular.	Perceived pain scores by nurses and caregivers were lower in children who used ShotBlocker^® during immunization. However, this effectiveness was not as evident in self-reports from children aged 36 months or older regarding their pain. However, children aged 72 months or older reported pain relief when using ShotBlocker^®.	II
S3	Çelik et al.(²⁵25 Çelik N, Khorshid L. The use of shotblocker for reducing the pain and anxiety associated with intramuscular injection: a randomized, placebo controlled study. Holist Nurs Pract. 2015;29(5):261-71. https://doi.org/10.1097/HNP.0000000000000105 https://doi.org/10.1097/HNP.000000000000... ) 2015 Turkey	To evaluate the effectiveness of ShotBlocker^® in reducing pain and anxiety associated with intramuscular injection in adults.	Study type: Randomized Placebo-Controlled Trial. Sample: 180 adults, aged 18 to 80 years. Setting: Outpatient clinic of a Public Hospital. Route of administration: Intramuscular.	Individuals who used ShotBlocker^® during intramuscular injection of sodium diclofenac (75 mg/3 mL) had significantly lower pain scores compared to individuals in the control and placebo groups. Therefore, ShotBlocker^® is recommended for relieving pain associated with intramuscular injection in adults. However, it did not reduce anxiety. Additionally, it may cause additional anxiety, so it is essential to introduce the device to individuals before use.	II
S4	Caglar et al.(²⁶26 Caglar S, Büyükyılmaz F, Coşansu G, Çağlayan S. Effectiveness of ShotBlocker for Immunization Pain in Full-Term Neonates: a randomized controlled trial. J Perinat Neonatal Nurs. 2017;31(2):166-71. https://doi.org/10.1097/JPN.0000000000000256 https://doi.org/10.1097/JPN.000000000000... ) 2017 Turkey	To examine the efficacy of ShotBlocker^® in controlling injection pain associated with the first intramuscular Hepatitis B vaccine administered to healthy full-term newborns.	Study type: Prospective Randomized Controlled Study Sample: 100 healthy full-term newborns. Setting: Ward of a private University Hospital. Route of administration: Intramuscular.	Pain scores from the Neonatal Infant Pain Scale (NIPS) at the time and post-injection were significantly lower in neonates who used ShotBlocker^® compared to the control group. Heart rate was lower in the intervention group three minutes after injection, but there was no significant difference in respiratory rate. ShotBlocker^® is recommended for relieving pain associated with intramuscular injection in healthy newborns.	II
S5	Emel et al.(²⁷27 Emel T, Nese C, Leyla K. Effects of ShotBlocker on Relief of Pain Due to Hepatitis B Vaccine Injection into Deltoid Muscle. Int J Caring Sci [Internet]. 2017 [cited 2023 Jun 17];10(3):1669-75. Available from: http://www.internationaljournalofcaringsciences.org/docs/62_5_toglru_original_10_3.pdf http://www.internationaljournalofcarings... ) 2017 Turkey	To examine the effects of ShotBlocker^® in relieving pain due to Hepatitis B vaccination in the deltoid muscle in adults.	Study type: Randomized Controlled Single-Blind Study. Sample: 242 individuals, aged 18 to 31 years. Setting: Nursing and Obstetrics Departments of a School of Health (University). Route of administration: Intramuscular.	There was no significant difference between the experimental and control groups regarding pain associated with Hepatitis B vaccine administered in the deltoid muscle. Therefore, ShotBlocker^® was not effective in pain reduction. However, it was observed that body mass index (BMI) interferes with pain perception, with pain decreasing as BMI increases.	II
S6	Canbulat Sahiner et al.(²⁸28 Canbulat Sahiner N, Turkmen AS, Acikgoz A, Simsek E, Kirel B. Effectiveness of two different methods for pain reduction during insulin injection in children with type 1 diabetes: buzzy and shotblocker. worldviews evid based nurs. 2018;15(6):464-70. https://doi.org/10.1111/wvn.12325 https://doi.org/10.1111/wvn.12325... ) 2018 Turkey	To compare the effect of ShotBlocker^® and the combination of vibration and cold application (Buzzy^®) in reducing pain during insulin administration in children.	Study type: Randomized Controlled Experimental Study. Sample: 60 children, aged 6 to 12 years. Setting: Department of Pediatric Endocrinology of a Medical School (University). Route of administration: Subcutaneous.	In perceived pain by caregivers and researcher/observer, as well as in children’s self-reports, children in the control group had higher pain scores compared to scores in the Buzzy^® and ShotBlocker^® groups. Anxiety scores of children in the Buzzy^® and ShotBlocker^® groups were lower compared to the control group. Children who used ShotBlocker^® had the lowest scores in both pain and anxiety.	II
S7	Aydin et al.(⁸8 Aydin E, Avşar G. Examining the effect of “Shotblocker” in relieving pain associated with intramuscular injection. Complement Ther Med. 2019;47:102192. https://doi.org/10.1016/j.ctim.2019.09.001 https://doi.org/10.1016/j.ctim.2019.09.0... ) 2019 Turkey	To examine the effect of ShotBlocker^® in relieving pain associated with intramuscular injection.	Study type: Controlled Quasi-Experimental Study. Sample: 50 women, aged 18 to 45 years. Setting: Hospital inpatient unit. Route of administration: Intramuscular.	The experimental group had statistically significant lower pain scores compared to the control group. The use of ShotBlocker^® is recommended in intramuscular injection services and protocols and dissemination of its scientific evidence as a non-pharmacological method to promote its use in nursing clinical practice.	III
S8	Bilge et al.(²⁹29 Bilge S, Aydin A, Gun C, Aldinc H, Acar YA, Yaylaci S, et al. Comparison of the efficacy of ShotBlocker and cold spray in reducing intramuscular injection-related pain in adults: a prospective, randomized, controlled trial. Saudi Med J. 2019;40(10):996-1002. https://doi.org/10.15537/smj.2019.10.24322 https://doi.org/10.15537/smj.2019.10.243... ) 2019 Turkey	To compare the efficacy of ShotBlocker^® and cold spray in reducing pain related to intramuscular injection in adults.	Study type: Prospective Randomized Controlled Study. Sample: 120 adults, aged 18 years and older. Setting: Emergency Medicine Department of a Medical School (University). Route of administration: Intramuscular.	ShotBlocker^® was considered an effective non-pharmacological method in reducing pain related to intramuscular injection, with no difference in effectiveness compared to cold spray. However, administering the injection with ShotBlocker^® was more challenging compared to cold spray, according to participants. Further studies are recommended to facilitate the use of ShotBlocker^® in clinical practice.	II
S9	Sivri Bilgen et al.(³⁰30 Sivri Bilgen B, Balcı S. The Effect on Pain of Buzzy® and ShotBlocker® during the Administration of Intramuscular Injections to Children: a randomized controlled trial. J Korean Acad Nurs. 2019;49(4):486-94. https://doi.org/10.4040/jkan.2019.49.4.486 https://doi.org/10.4040/jkan.2019.49.4.4... ) 2019 Turkey	To investigate the effect of Buzzy^® and ShotBlocker^® in reducing pain induced by intramuscular penicillin injections in children.	Study type: Randomized Controlled Study. Sample: 150 children, aged 7 to 12 years. Setting: Pediatric Emergency Clinic. Route of administration: Intramuscular.	Children in the control group had significantly higher pain scores during penicillin injection than children in the ShotBlocker^® and Buzzy^® groups. The Buzzy^® group had the lowest pain scores compared to the ShotBlocker^® and control groups. However, ShotBlocker^® had lower scores compared to the control group, being a non-pharmacological option for relieving pain associated with intramuscular injection. Anxiety assessed before the procedure did not have a statistically significant difference between the groups.	II
S10	Yilmaz et al.(³¹31 Yilmaz G, Alemdar DK. Using Buzzy, Shotblocker, and Bubble Blowing in a Pediatric Emergency Department to Reduce the Pain and Fear Caused by Intramuscular Injection: a randomized controlled trial. J Emerg Nurs. 2019;45(5):502-11. https://doi.org/10.1016/j.jen.2019.04.003 https://doi.org/10.1016/j.jen.2019.04.00... ) 2019 Turkey	To compare the effectiveness of Buzzy^®, ShotBlocker^®, and bubble-blowing in reducing pain and fear associated with intramuscular injection in children.	Study type: Prospective Randomized Clinical Trial. Sample: 160 children, aged 5 to 10 years. Setting: Hospital Pediatric Emergency Room. Route of administration: Intramuscular.	Pain and fear were significantly lower in children who used Buzzy^® compared to the control, ShotBlocker^®, and bubble blowing groups. However, children in the ShotBlocker^® group also had lower pain and fear scores compared to the control and bubble blowing groups. Thus, ShotBlocker^® and Buzzy^® devices are recommended during intramuscular injection to reduce childhood pain and fear associated with the procedure.	II
S11	Şanlialp Zeyrek et al.(³²32 Zeyrek AS, Takmak Ş, Kurban NK, Arslan S. Systematic review and meta-analysis: physical-procedural interventions used to reduce pain during intramuscular injections in adults. J Adv Nurs. 2019;75(12):3346-61. https://doi.org/10.1111/jan.14183 https://doi.org/10.1111/jan.14183... ) 2019 Turkey	Evaluate the effectiveness of physical-processual interventions in reducing pain during intramuscular injections.	Study type: Systematic Review and Meta-Analysis. Sample: 15 studies. Setting: Not applicable. Route of administration: Intramuscular.	The ShotBlocker^® is a tool to be considered for relieving pain associated with intramuscular injections.	I
S12	Inangil et al.(³³33 Inangil D, Şendir M. Effectiveness of mechano-analgesia and cold application on ecchymosis, pain, and patient satisfaction associated with subcutaneous heparin injection. J Vasc Nurs. 2020;38(2):76-82. https://doi.org/10.1016/j.jvn.2020.02.002 https://doi.org/10.1016/j.jvn.2020.02.00... ) 2020 Turkey	Investigate the effect of mechanoneuroanalgesia and cold application on bruising, pain, and patient satisfaction for subcutaneous heparin injection.	Study type: Prospective Controlled Quasi-Experimental Clinical Research. Sample: 55 adults, aged 18 years and older. Setting: Orthopedics and Traumatology Wards of a University Hospital. Route of administration: Subcutaneous.	Both the use of mechanical analgesia through ShotBlocker^® and cold application reduced the pain associated with subcutaneous heparin injection. ShotBlocker^® was ineffective in reducing bruising but obtained a higher level of satisfaction with statistical significance.	III
S13	Ayinde et al.(³⁴34 Ayinde O, Hayward RS, Ross JDC. The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis. PloS One. 2021;16(5):e0250883. https://doi.org/10.1371/journal.pone.0250883 https://doi.org/10.1371/journal.pone.025... ) 2021 United Kingdom	Review the effect of different intramuscular injection techniques on injection-associated pain in adults.	Study type: Systematic Review and Meta-Analysis. Sample: 29 studies. Setting: Not applicable. Route of administration: Intramuscular.	Contradictory evidence was observed regarding the effectiveness of ShotBlocker^®, where one study shows a reduction in pain associated with intramuscular injection, while another study asserts that the pain was similar in the control and intervention groups. It is worth noting that the difference between the results may be related to a larger study population, smaller injection volume, and a healthier patient group.	I
S14	Kolcu et al.(³⁵35 Kolcu M, Celik S, Bulbul E, Sendir M, Issever H, Yalcinkaya S. The Use of Shotblocker for subcutaneous injection pain, anxiety and satisfaction in chronic spontaneous urticaria patients: a randomized clinical trial. Int J Caring Sci [Internet]. 2021 [cited 2023 Jun 18];14(1):1098-105. Available from: http://www.internationaljournalofcaringsciences.org/docs/32_kolcu_original_14_2.pdf http://www.internationaljournalofcarings... ) 2021 Turkey	Investigate the effect of ShotBlocker^® on pain levels, anxiety, and satisfaction in subcutaneous injection of patients with chronic spontaneous urticaria.	Study type: Randomized Controlled Clinical Trial. Sample: 90 individuals, aged 18 years and older. Setting: Dermatology Clinic of a University Hospital. Route of administration: Subcutaneous.	Regarding pain and anxiety levels, there was no statistically significant difference between the ShotBlocker^®, placebo, and control groups in the assessment after the injection. Regarding satisfaction levels after injection, the ShotBlocker^® group had a statistically high outcome compared to the placebo and control groups. However, it is believed that ShotBlocker^® could be presented to patients as an option due to its easy and cost-effective use.	II
S15	Şahan et al.(³⁶36 Şahan S, Yildiz A. The Effect of ShotBlocker Application on intramuscular injection pain in adults: a meta-analysis. Clin Nurs Res. 2021;31(5):820-5. https://doi.org/10.1177/10547738211021225 https://doi.org/10.1177/1054773821102122... ) 2021 Turkey	Determine the effects of ShotBlocker^® application during intramuscular injection administration in adult patients to provide evidence-based practice.	Study type: Literature Review with Meta-Analysis. Sample: 5 studies. Setting: Not applicable. Route of administration: Intramuscular.	Pain levels in the experimental group where ShotBlocker^® was used during intramuscular injection in adult patients were significantly different compared to the control group. As a result of the meta-analysis, it was found that the application of ShotBlocker^® in intramuscular injection in adult patients reduced the intensity of patients’ pain.	I
S16	Yildirim et al.(³⁷37 Yildirim D, Dinçer B. Shotblocker use in emergency care: a randomized clinical trial. Adv Emerg Nurs J. 2021;43(1):39-47. https://doi.org/10.1097/TME.0000000000000330 https://doi.org/10.1097/TME.000000000000... ) 2021 Turkey	Evaluate the effect of ShotBlocker^® on pain and satisfaction of intramuscular injection in adult emergency patients.	Study type: Randomized Clinical Trial. Sample: 74 individuals, aged 18 years and older. Setting: Hospital Adult Emergency Department. Route of administration: Intramuscular.	The level of pain in the ShotBlocker^® group was lower compared to the control group. Meanwhile, the satisfaction level in the ShotBlocker^® group was higher compared to the control group. In both cases, the difference was statistically significant.	II
S17	Gürdap et al.(³⁸38 Gürdap Z, Cengiz Z. Comparison of cold spray and shotblocker to reduce intramuscular injection pain: a randomized controlled trial. J Clin Pharm Ther. 2022;47(8):1249-56. https://doi.org/10.1111/jcpt.13663 https://doi.org/10.1111/jcpt.13663... ) 2022 Turkey	Compare the effects of cold spray and ShotBlocker^® on pain reduction in adults caused by intramuscular injection in the adult emergency department.	Study type: Randomized Controlled Clinical Trial. Sample: 195 individuals, aged 18 years and older. Setting: University Hospital Adult Emergency Department. Route of administration: Intramuscular.	Cold spray proved to be the best resource for managing pain associated with intramuscular injection. However, ShotBlocker^® is also an option for pain reduction, as it was effective when compared to both the control group and placebo groups.	II
S18	Savcı et al.(³⁹39 Savcı C, Özkan B, Açıksarı K, Solakoğlu GA. Effectiveness of two different methods on the perceived pain and satisfaction during intramuscular antibiotic injection: ShotBlocker and Local Vibration. Clin Nurs Res. 2022;31(5):812-9. https://doi.org/10.1177/10547738211051877 https://doi.org/10.1177/1054773821105187... ) 2022 Turkey	Examine the effectiveness of ShotBlocker^® and local vibration on pain perception and satisfaction during intramuscular antibiotic injection.	Study type: Randomized Controlled Experimental Study. Sample: 100 individuals, aged 18 years and older. Setting: Hospital Adult Emergency Department. Route of administration: Intramuscular.	Local vibration application was more effective in reducing pain and increasing satisfaction during intramuscular antibiotic injection compared to the ShotBlocker^® and control groups. It is noted that pain scores were lower and satisfaction scores were higher in the ShotBlocker^® group compared to the control group.	II
S19	Zengin et al.(⁴⁰40 Zengin M, Yayan EH. A Comparison of two different tactile stimulus methods on reducing pain of children during intramuscular injection: a randomized controlled study. J Emerg Nurs. 2022;48(2):167-80. https://doi.org/10.1016/j.jen.2021.10.006 https://doi.org/10.1016/j.jen.2021.10.00... ) 2022 Turkey	Test a new non-pharmacological intervention to reduce needle-related pain in the pediatric emergency department.	Study type: Randomized Controlled Clinical Trial. Sample: 159 children, aged 7 to 10 years. Setting: Pediatric Emergency Department. Route of administration: Intramuscular.	In the perceived pain by caregivers and researcher/observer, as well as in the children’s self-reports, pain scores in the Palm Stimulator group were statistically and significantly lower compared to the ShotBlocker^® and control groups. Although the perception of pain levels in the ShotBlocker^® group was lower than in the control group, this difference was not statistically significant. Regarding pre-procedural fear, there was no difference between the groups.	II
S20	Cmc et al.(⁴¹41 Cmc S, Lord H, Vargese SS, Kurian N, Cherian SA, Mathew E, et al. Effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections: a systematic review and meta-analysis. JBI Evid Synth. 2023;21(2):373-400. https://doi.org/10.11124/JBIES-20-00590 https://doi.org/10.11124/JBIES-20-00590... ) 2023 India	To synthesize the best available research evidence regarding the effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections.	Study type: Systematic Review and Meta-analysis. Sample: 25 studies. Setting: Not applicable. Route of administration: Intramuscular.	ShotBlocker^® is effective in reducing pain associated with intramuscular injection. However, it is observed that the device may increase patients’ anxiety levels. It is reinforced that it is a promising technique in the management of pain associated with intramuscular injection, with low cost, and can be easily taught/learned.	I

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Jefferson Wildes da Silva Moura, E-mail: jefferson.wsmoura@gmail.com