Comparison of the Effects of Vapocoolant Spray and Topical Anesthetic Cream on Pain During Needle Electromyography in the Medial Gastrocnemius

doi:10.1016/j.apmr.2012.12.008

Archives of Physical Medicine and Rehabilitation

Volume 94, Issue 5, May 2013, Pages 919-924

https://doi.org/10.1016/j.apmr.2012.12.008 Get rights and content

Abstract

Objective

To compare the effects of a vapocoolant spray and an eutectic mixture of local anesthetics (EMLA) cream in reducing pain during needle electromyography examination.

Design

Randomized controlled trial.

Setting

Physical medicine and rehabilitation department of a university hospital.

Participants

Adults who underwent needle electromyography (N=99) were randomized to 1 of 2 experimental groups or the control group. Two patients dropped out during the study.

Interventions

In the experimental groups, vapocoolant spray or EMLA cream were applied before needle electromyography. In the control group, needle electromyography was performed without pretreatment.

Main Outcome Measures

Intensity of pain associated with needle electromyography was assessed using a 100-mm visual analog scale (VAS). Patient satisfaction and preference for repeated use were measured using a 5-point Likert scale.

Results

VAS score for pain intensity was significantly lower in the spray group (31.9; 95% confidence interval [CI], 22.0–41.7) compared with the control group (52.9; 95% CI, 45.9–60.0; P=.002), whereas there was no significant difference between the EMLA cream group (42.4; 95% CI, 34.2–50.7) and the control group. Patient satisfaction and preference for repeated use were higher in the spray group than the EMLA group.

Conclusions

Vapocoolant spray was more effective than EMLA cream in reducing pain during needle electromyography.

Section snippets

Methods

This study was approved by the institutional review board. All patients were informed of the study and provided written consent. The study was conducted on patients aged from 19 to 70 years old who had a normative schedule of needle electromyography in the lower extremity at the university hospital's electromyography clinic. The following patients were excluded from the study: those who refused to participate, those who were unable to understand a visual analog scale (VAS) or a Likert scale,

Results

A total of 99 patients were enrolled; 2 patients dropped out. One patient in the control group refused to continue the needle electromyography examination because of intolerable pain. One patient in the spray group was dropped because the electromyography practitioner entered the electromyography room while the spray was being applied. In total, 97 patients completed the study protocol (32 in the control group, 33 in the EMLA cream group, and 32 in the spray group) (fig 1). The groups did not

Discussion

In this study, vapocoolant spray was more effective than EMLA cream in preventing pain during needle electromyography examination. There was higher satisfaction and preference for the vapocoolant spray in the subjects.

During the needle electromyography examination, a needle connected to recording instruments must be inserted into not only the skin but also the muscle. The introduction of a needle through the skin into a muscle is a painful procedure, usually conducted without appropriate

Conclusions

On comparing the analgesic effects of vapocoolant spray and EMLA cream during needle electromyography, we reached the following conclusions: (1) the group that received vapocoolant spray during needle electromyography had significantly lower VAS scores than the control group; and (2) compared with the EMLA cream group, the vapocoolant spray group had a significantly higher level of satisfaction with the pain reduction method used during needle electromyography and a greater willingness to try

Suppliers

a.
Walter Ritter GmbH and Co, Spaldingstraße 110 B, Hamburg, 20097, Germany.
b.
Alpine Biomed, 1501 Industrial Rd, San Carlos, CA 94070.
c.
SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

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In a study by Moon et al., it has been shown that Vapocoolant spray can be used effectively and rapidly to reduce pain during needle electromyography [15]. Another study has shown that Vapocoolant spray significantly reduces pain during intravenous cannulation in both adults and children compared to placebo spray or no treatment [6,15]. In their randomized controlled trial, Hijazi et al. have found Vapocoolant spray to be an effective, acceptable, and safe method of pain reduction for venous cannulation [16].
The digital nerve block is an effective method of anesthesia before minor surgical interventions on the fingers. However, patients may experience a lot of pain and anxiety during this procedure. The efficacy of topical vapocoolant spray during minor procedures has been demonstrated in previous studies. we aimed to evaluate the effectiveness of topical vapocoolant spray in reducing pain during digital nerve block.
This prospective, randomized clinical study was conducted to evaluate the effectiveness of vapocoolant spray application in reducing pain during digital block. The patients were categorized into 2 groups as spray-treated and control group. A routine digital block process was applied to the control group. Spray application was performed in two groups of 50 each, in a manner of bilateral and unilateral to the finger. Demographic data of the patients, such as gender, age, dominant hand, injury patterns, injection site and injury sites, were recorded. After the application, the patients' visual analog scale (VAS) was evaluated.
Of the participants, 100 were randomly assigned to the vapocoolant spray-treated group, and 50 were included in the control group. The VAS pain score during penetration in both spray groups was significantly lower than the control group (p < 0.001). Pain change during penetration was found to be significantly lower in the bilateral spray-treated group compared to the control group (p < 0.001). Pain change during infiltration was significantly lower in both spray groups compared to the control group (p < 0.001).
Spray application prior to digital nerve blocking can be used to reduce needle penetration pain associated with this procedure and pain associated with local anesthetic infiltration.
Topical lidocaine hydrochloride 4% spray on pain perception during the needle electromyography: A prospective study
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Comparison of the Effects of Vapocoolant Spray and Topical Anesthetic Cream on Pain During Intraarticular Injection of the Shoulder: A Randomized Double-Blind Controlled Trial
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Adverse effects related to the vapocoolant spray are extremely rare and include alteration of the skin pigmentation and cutaneous sensitization, neither of which was observed in this trial.19 In addition, the vapocoolant spray has the advantages of extremely rapid effect, short application time, increased convenience, and low cost ($0.18 per procedure).19,22 In this trial, the spray group reported significantly greater participant satisfaction and preference for repeated use compared with the placebo group; however, there were no significant differences between the spray and EMLA groups.
This study was performed to compare the effects of a vapocoolant spray and a eutectic mixture of local anesthetics (EMLA) cream on reducing pain during intra-articular (IA) injection of the shoulder.
Double-blind randomized placebo-controlled clinical trial.
University hospital.
Patients (N=63) who underwent IA injection of the shoulder joint were randomized into the spray group, EMLA group, or placebo group.
Placebo cream+vapocoolant spray (spray group), EMLA cream+placebo spray (EMLA group), or placebo cream+placebo spray (placebo group) before IA injection.
A 100-mm visual analog scale (VAS) for injection pain and 5-point Likert scales for participant satisfaction and preference for repeated use were administered immediately after IA injection.
The VAS scores for pain during IA injection were 30.0 (95% CI, 19.7-41.2) in the spray group, 50.0 (95% CI, 37.7-63.0) in the EMLA group, and 53.8 (95% CI, 41.6-65.0) in the placebo group (F=6.403, P<.01). The spray group showed significantly better Likert scale scores than the placebo group for participant satisfaction (P=.003) and preference for repeated use (P<.001).
Vapocoolant spray was effective in reducing pain during IA injection of the shoulder.
<sup>18</sup> F-FDG positron emission tomography as a novel diagnostic tool for peripheral nerve injury
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Electromyography (EMG) detects abnormal muscle cell membrane potential, which indicates muscle denervation resulting from peripheral nerve injury and has since become a major electrodiagnostic tool (Daube and Rubin, 2009). However, it has several disadvantages, including its invasiveness and associated pain (Moon et al., 2013); moreover, it takes time for the nerve or muscle below the area damaged by peripheral nerve injury to display abnormalities (Buchthal and Rosenfalck, 1966). For example, in plexus injury, abnormal spontaneous activities (ASA) on EMG occur within 1 to 6 weeks after injury, depending on the distance between the injury site and the muscle fiber (Amato and Dumitru, 2002).
Glucose hypermetabolism in denervated skeletal muscle suggests the potential for developing a diagnostic tool for peripheral nerve injuries. Herein, we investigated the characteristics and molecular mechanism of this phenomenon.
Temporal course of glucose hypermetabolism and development of abnormal spontaneous activities (ASA) through electromyography (EMG) were investigated in rats with complete sciatic nerve injuries. Rats with partial sciatic nerve injuries were used to investigate the relationship between nerve injury severity and change in glucose metabolism. Rapamycin-treated rats were used to study molecular mechanism. Mean lesion-to-normal count ratios (LNR_mean) was calculated as a numeric value of the ¹⁸F-FDG uptake.
Glucose hypermetabolism began 2 days after nerve injury and lasted up to 12 weeks, with the maximum increase at 1 week after denervation (10-fold increase compared to sham-operated muscle; LNR_mean, sham, 1.360 ± 0.452; denervation, 10.340 ± 4.094; n = 5; P < 0.05). The metabolic changes showed similar temporal characteristics to ASA on EMG. The signal intensity of ¹⁸F-FDG uptake in denervated skeletal muscle was strongly related to nerve injury severity in a partial nerve injury model (Pearson correlation coefficient 0.63, P < 0.05). Suppression of mTOR by rapamycin treatment reduced the increase in peak glucose hypermetabolism in muscle denervation.
Metabolic changes in ¹⁸F-FDG PET scans have a wider time span than abnormalities on EMG after denervation and it is correlated with the severity of nerve injury assessed by NCS.
¹⁸F-FDG PET may be used to diagnose and evaluate peripheral nerve injuries.
<sup>18</sup> F-ASEM PET/MRI targeting alpha7-nicotinic acetylcholine receptor can reveal skeletal muscle denervation
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: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: Clinical Trial No.: NCT01606046.

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Original articleComparison of the Effects of Vapocoolant Spray and Topical Anesthetic Cream on Pain During Needle Electromyography in the Medial Gastrocnemius

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Suppliers

J Pediatr

Arch Phys Med Rehabil

J Am Acad Dermatol

J Emerg Med

Br J Anaesth

Pain

Eur J Pain

Needle electromyography

Electrophysiologic evaluation of lumbosacral radiculopathies: electromyography, late responses, and somatosensory evoked potentials

Neurology

Control of pain during electromyography

Arch Phys Med Rehabil

Prospective double-blind crossover trial of ibuprofen in reducing EMG pain

Muscle Nerve

Use of nonsteroidal antiinflammatory drugs in dental practice. A review

Med Oral Patol Oral Cir Bucal

Original article
Comparison of the Effects of Vapocoolant Spray and Topical Anesthetic Cream on Pain During Needle Electromyography in the Medial Gastrocnemius