The Effect of the Cold Application on Venous Cannulation Pain
Condition: Venous Cannulation Pain; Nervous Vagus; Cold
Study type: Interventional

Summary: 
      Intravenous (iv) cannulation is one of the most common practices performed by
      anesthesiologists in and outside the operating room. Vascular access is required before any
      anesthetic procedure. Venous cannulation is a moderately painful procedure and is
      uncomfortable for patients, and the pain of intravenous cannulation can increase the
      patient's stress. Various methods are used to reduce cannulation pain. N. Vagus stimulation
      is among these methods (1). In this study, we aim to evaluate vascular access pain by
      stimulating the Nervus Vagus with the cold application method to the neck region of our
      patients who applied venous cannulation from the back of the hand before anesthesia.
    

Detailed description: 
      Various ways have been tried to reduce cannulation pain. Methods such as local anesthetic
      injection to the intervention area, topical anesthetic use, ice application, and vibrating
      buzzi application were used to relieve the patient's pain and distract him. There are many
      different methods of stimulating the vagus nerve. The Valsalva maneuver is a mechanism that
      stimulates the Nervus Vagus (N. Vagus). Stimulation of the vagus nerve is thought to have an
      analgesic effect (2). Stimulation of the vagal nerve has an antinociceptive effect by
      triggering the baroreceptor reflex arc. It is thought that a P-like substance is released
      from the antinociceptive substance with the activation of the baroreceptor reflex arc. The
      regions where the N. Vagus is most superficial in the periphery are the inner auricle and the
      lateral neck region. It is also known that cold application to the lateral neck region
      stimulates the N. Vagus and reduces the heart rate (3). Applying cold to the neck area will
      have an antinociceptive effect by activating the baroreceptor reflex arc by stimulating the
      N. vagus. Patients between the ages of 18-70 who will be operated on electively (excluding
      those who will undergo oncological surgery and those who will undergo cesarean section) will
      be included in the study. These patients will be evaluated in the anesthesia polyclinic
      before the operation. Those with scars on the dorsum of the hand, operated on the dorsum of
      the hand, psoriasis, peripheral vascular disease, chronic analgesic use, opioid use, steroid
      use, gabapentin use, a history of substance abuse, peripheral neuropathy, oncological
      treatment, and limited cooperation patients will not be included in the study. The patients
      will be divided into 3 groups Group K, Group M, and Group S, with 53 people in each group.
      (The number of patients in the groups was calculated as α=0.05 and β=0.80 when power analysis
      was performed. The lottery method will be used for randomization.

      Group K: Control group; 30 seconds (sec) will wait before the vascular access is opened, no
      additional action will be taken.

      Group M: Cold application group; Just before the vascular access was opened, a marble plaque
      was placed on the carotid (2-3 cm above the clavicle, on the sternocleidomastoid muscle (SCM)
      2-3 cm above the clavicle) in the bilateral neck region, 4x5 cm in size, for 30 seconds.

      Group S: Sham group; Before the vascular access is opened, a marble plaque of 4x5 cm with a
      polar sheath will be applied bilaterally to the neck area of the patients for 30 seconds.

      After the patients are taken to the operating room and monitored, we will use the method
      suitable for the groups we determined by drawing lots. Heart rate (HR), respiratory rate
      (RR), and noninvasive blood pressure (NIBB) will be recorded before the intravenous line is
      opened.HR, RR, and NIBB values will be recorded after the application to the neck area. Then,
      an 18 gauge (green) intravenous cannula will be inserted at once by the same experienced
      practitioner on the back of the left hand, and patients will be asked to rate their pain
      levels between 0-10 according to Numerical Rating Scale (NRS), and this value will be
      recorded. HR, RR, and NIBB values will also be recorded. Patients who cannot be cannulated at
      once will be excluded from the study.

      The data of the patients will be recorded using the Statistical Package for the Social
      Sciences (SPSS) 18 program. The relationship between the NRS scores of all three groups and
      the patients' HR, RR, and NIBB values before cold application, after cold application, and
      during vascular access will be evaluated. Descriptive statistics, analysis of variance, and
      chi-square test will be used in the evaluation of the data. Mean±standard deviation and
      percentiles will be used in descriptive statistics. Results will be evaluated at a 95%
      confidence interval and significance as p<0.05.
    

Intervention name(s): non-interventional clinical research
Intervention type(s): Other
Intervention description(s): This study is a non-invasive clinical trial designed to observe the effect of applying cold to the neck area to effect of venous cannulation pain
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Prevention