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

J Adv Nurs. 2019 Dec;75(12):3346-3361. doi: 10.1111/jan.14183. Epub 2019 Sep 13.


Aims: To assess the effectiveness of physical-procedural interventions in reducing pain during intramuscular injections.

Design: Systematic review and meta-analysis.

Method: English keywords were used to search databases [MEDLINE (OVID, Ebsco), SCOPUS, Science Direct, COCHRANE and the reference lists from retrieved articles] from their inception to November 2017 and randomized and quasi-experimental trials were selected based on inclusion and exclusion criteria. The standardized mean difference and random effects model were used.

Results: From 2,318 articles, 15 articles (1996-2017) met the criteria for the meta-analysis. Physical-procedural interventions described in the articles were included in this systematic review. The overall standardized mean difference was 0.595 (95% confidence interval (CI) = 0.417-0.773), indicating a moderate effect on pain levels. Generally, these interventions (two-needle technique, acupressure, manual pressure, ShotBlocker, Z-technique, air-lock technique, injection site postinjection massage, and speed of injection) have been found to moderately reduce pain.

Conclusion: It seems difficult to conclude that a single intervention reduces pain in adults. However, we can state that the most effective interventions for reducing pain during intramuscular injections in adults involve the ventrogluteal site, the Z-technique, and manual pressure.

Impact: The systematic review will provide guidance to clinicians, staff, and educator nurses and future studies. The systematic review will help nurses and educators apply techniques based on evidence in any setting. The systematic review will guide well-designed and well-reported studies to contribute to the accumulation of evidence in nursing research.

目的: 在于评估物理类过程性干预措施在减少肌肉注射疼痛中的有效性。 设计: 系统综述和荟萃分析。 方法: 从创建到2017年11月,使用了英文关键词来搜索数据库【MEDLINE (OVID,Ebsco),SCOPUS,Science Direct,COCHRANE和检索文章的参考文献列表】,并根据纳入和排除标准选择了随机试验和准实验试验。采用了标化均数差值和随机效应模型。 结果: 在2318篇文章中,有15篇文章(1996-2017年)符合荟萃分析的标准。总体标化均数差值0.595 (95%置信区间(简称为“CI”)= 0.417-0.773),表明对疼痛级别有缓和效用。一般来说,经证实,这些干预措施(双针技巧、针压法、手动施压、ShotBlocker、Z技巧、气闸技巧、注射部位注射后按摩和注射速度)能适度减轻疼痛。 结论: 似乎很难断定单次干预措施就能减轻成年人的疼痛。然而,我们可以说,要减轻成人肌肉注射过程中疼痛,最为有效干预措施就是侧臀部位、Z技巧和手动施压。 影响: 系统综述将为临床医生、工作人员、教育工作者、护理教育者和未来研究提供指导。系统综述将会帮助护理教育者在任何环境下采用基于证据的技巧。系统综述将给精心设计和报告的研究提供指导,从而有助于护理研究的证据积累。.

Keywords: adults; intramuscular injection; meta-analysis; nurse; nursing; physical intervention; procedural intervention pain; systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Humans
  • Injections, Intramuscular / adverse effects*
  • Pain / etiology*
  • Pain Management / methods*
  • Randomized Controlled Trials as Topic