Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques

Mitesh Chawda; Guruveerajeyasingh Malini; Subodh Kumar Saha; Shantilal Chawda; Ganpat Jha; Ashish Wanare; Ravi Prakash Pandey; Hitav Someshwar

doi:doi:10.11648/j.ajp.20190503.19

Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques

Mitesh Chawda, Guruveerajeyasingh Malini, Subodh Kumar Saha, Shantilal Chawda, Ganpat Jha, Ashish Wanare, Ravi Prakash Pandey, Hitav Someshwar

Published in American Journal of Pediatrics (Volume 5, Issue 3)

Received: 8 May 2019 Accepted: 24 June 2019 Published: 6 August 2019

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Abstract

Background: Immunisations is one of commonest cause of iatrogenic pain among healthy infants though several authorities have recommended that no aspiration is required before injecting into the anterolateral thigh, it is still a commonly followed procedure. Method: 202 healthy infants of either sex of age group 6 weeks to 6 months receiving routine intramuscular pentavalent vaccine were selected randomly by computer generated numbers and divided into two groups “standard” group and “pragmatic” group with 101 infants in each group. Two methods of vaccination conventional and pragmatic are used. In both cases pre vaccination and post vaccination pain was accessed by using FLACC scale and modified behavioural pain scale as well as cry time was noted. Results: The pre vaccination mean FLACC score in standard group is 2.07 (±1.17) while that in pragmatic group is 1.79 (±1.28). Post vaccination mean FLACC score in standard group is 8.5 (±0.82) while that in pragmatic group is 7.79 (±1.25). The pre vaccination mean MBPS in both standard & pragmatic group is 2.16 (±1.07). The post vaccination mean MBPS in standard group is 8.13 while that in pragmatic group is 8.16. Conclusions: Our study revealed that there was significant difference in perception of pain among the two groups. The Pragmatic group being a better technique for vaccination.

Published in	American Journal of Pediatrics (Volume 5, Issue 3)
DOI	10.11648/j.ajp.20190503.19
Page(s)	133-141
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Vaccination Pain, Infant Vaccination, Different Technique

References

[1]	Schechter NL, Berde CB, Yaster M. Pain in infants, children, and adolescents: an overview. In: Schechter NL, Berde CB, Yaster M, eds. Pain in Infants, Children, and Adolescents. Baltimore, MD: Williams & Wilkins; 1993: 3-9.
[2]	Walco GA, Cassidy RC, Schechter NL. Pain, hurt, and harm: the ethics of pain control in infants and children. N Engl J Med. 1994; 331: 541-544.
[3]	Jay S. Invasive medical procedure: psychological intervention and assessment. In: Routh D, ed. Handbook of pediatric psychology. New York: Guilford, 1998: 410-25.
[4]	Jacobson RM, Swan A, Adegbenro A, Ludington SL, Wollan PC, Poland GA, Vaccine Research Group. Making vaccines more acceptable—methods to prevent and minimize pain and other common adverse events associated with vaccines. Vaccine. 2001 Mar 21; 19 (17-19): 2418-27.
[5]	The Vaccine Administration Taskforce. UK Guidance on best practice in vaccine administration, London: Shire Hall communications, 2001.
[6]	Choidini J. Best practice in vaccine administration. Nurs Stand 2001; 16: 35-8.
[7]	Beyea S, Nicoll L. Administration of medications via the intramuscular route: an integrative review of the literature and research-based protocol for the procedure. Appl Nurs Res 1995; 8: 23-3.
[8]	Rodger MA, King L. Drawing up and administering intra muscular injections:a review of the literature. J Adv Nurs 2000; 31: 574-82.
[9]	Zelmen S. notes on techniques of intramuscular injection. Am J Med Sci1961; 241: 47-58.
[10]	Chiodini J. Vaccine administration. Nurs Stand 2000; 14: 38-42.
[11]	Workman B. Safe injection technique. Nurs Stand 1999; 13: 47-53.
[12]	Nicoll LH, Hesby A. IM injection: An integrative research review and guideline for evidence based practice. Appl Nurs Res 2002; 15: 149-162.
[13]	National Research Council. Recognition and alleviation of pain in laboratory animals. National Academies Press; 2010 Jan 14.
[14]	The Assessment and Management of Acute Pain in Infants, Children and Adolescents. PEDIATRICS Vol. 108 No. 3 September 2001 793-797.
[15]	Schechter NL, Allen DA, Hanson K. Status of pediatric pain control: a comparison of hospital analgesic usage in children and adults. Pediatrics 1986; 77: 11-5.
[16]	McGrath PA, Brigham MC. The assessment of pain in children and adolescents. In: Turk DC, Melzack R, eds. Handbook of Pain Assessment. New York, NY: Guilford Press; 1992: 295-314.
[17]	Jay SM, Elliot CH. A stress inoculation program for parents whose children are undergoing painful medical procedures. J Consult Clin Psychol. 1990; 58: 799-804.
[18]	Berry PH, Chapman CR, Covington EC, Dahl JL, Katz JA, Miaskowski C, McLean MJ. Pain: current understanding of assessment, management, and treatments. National Pharmaceutical Council and the Joint Commission for the Accreditation of Healthcare Organizations, VA, USA. 2001 Dec: b44.
[19]	Crellin DJ, Harrison D, Santamaria N, Huque H, Babl FE. The Psychometric Properties of the FLACC Scale Used to Assess Procedural Pain. J Pain. 2018 Mar 15.
[20]	Merkel S, Voepel-Lewis T, Shayevitz JR, et al:The GLACC: A behavioural scale for scoring postoperative pain in young children. Pediatric nursing 1997; 23:293-797. Robieux I Kumar R et al. Assessing pain and analgesia with a lidocaine prilocaine emulsion in infants and toddlers during venipucture. J Pediatr. 1991; 118: 971-973.
[21]	Taddio A Nulman I et al. A revised measure of acute pain in infants. J Pain.
[22]	Symptom Manage. 1995; 10: 456-463.
[23]	Wikipedia, the free encyclopedia. Immunization. Available at: https://en.wikipedia.org/wiki/Immunization. Accessed March 21, 2018].
[24]	Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations Neil L. Schechter et al Pediatrics 2007; 119; e1184-e1198.
[25]	Available at: http://www.iapcoi.com/pdf/chapter01introduction. Accessed March 21, 2018.
[26]	Available at: http://www.iapindia.org/page.php?id=129. Accessed December 5, 2017.
[27]	Available at:http://www.who.int/immunization/policy/Immunization_routine_table2 accessed on 10/05/2018. Accessed October 2, 2017.
[28]	Availableat:http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/D/vacc_a dmin accessed on 08/05/2018. Accessed March 16, 2018.
[29]	World Health Organization. Safety of injections in immunization programmes: WHO recommended policy. InLogistics for Health Information Series (WHO) 1994. World Health Organization.
[30]	Hanson DJ. IM injection injuries and complications. Am J Nurs 1963; 63: 99-101.
[31]	Diggle L, Deeks J. Effect of needle length on incidence of local reactions to routine immunization in infants aged 4 months. BMJ 2000; 321: 931-933.
[32]	Available at: http://www.iapcoi.com/pdf/chapter08practicalaspects accessed on 10/05/2018. Accessed March 16, 2018.
[33]	Availableat:http://www.dh.gov/prod_consum_dh/groups/dh_digitalassests/@dh/@en/d ocuments/digitalasset/dh_121552 p 26 accessed 10/05/2018. Accessed October 24, 2017.
[34]	Bergeson PS, Singer SA, Kaplan AM. IM injections in children. Pediatrics 1982; 70: 944-948.
[35]	Beyea SC, Nicoll LH. Administration of medications via IM route: An integrative review of literature and research based protocol for the procedure. Appl Nurs Res 1995; 8: 23-33.
[36]	Groswasser J, Kahn A, Bouche B, Hanquinet S, Peri muter N, Hessel L. Needle length and injection technique for efficient IM vaccine delivery in infants and children evaluated through an ultrasonographic determination of subcutaneous and muscle layer thickness. Pediatrics 1997; 100: 400-403.
[37]	Nicoll LH. IM injection: updated information. SIGN September. 2002; 1-2.
[38]	Clements CJ. Aspiration before injection. SIGN January; 2003; 1-2.
[39]	Mary Catlin. Aspiration before injection: Part 2. SIGN January 2003; 1-2.
[40]	CDC. Vaccine Administration. In: General recommendations on Immunisation. Eds. William LA, Larry P, Benjamin S, Bruce W, John lskander, John Watson, Atlanta, USA. MMWR 2002; 51 (RR02): 11-14.
[41]	Taddio A, Wong H, Welkovics B, Ilersich AL, Cole M, Goldbach M, Ipp M. A randomized trial of the effect of vaccine injection speed on acute pain in infants. Vaccine. 2016 Sep 7; 34 (39): 4672-7.
[42]	O’Brien L, Taddio A, Ipp M, et al. Topical 4% amethocaine gel reduces the pain of subcutaneous measles-mumps-rubella immunization. Pediatrics 2004; 114: e720-4.
[43]	Taddio A, Nulman I, Goldbach M, et al. Use of lidocaine-prilocaine cream for immunization pain in infants. J Pediatr 1994; 124: 643-8.
[44]	Ipp MM, Gold R, Greenberg S, et al. Acetaminophen prophylaxis of adverse reactions following immunization of infants with diphtheria-pertussis-tetanustoxoids-polio vaccine. Pediatr Infect Dis J 1987; 6: 721-5.
[45]	Huang FY, Huang LM. Effect of local massage on immunization: DTP and DTPa. Acta Paediatr Taiwan 1999; 40: 166-70.
[46]	Girish GN, Ravi MD. Vaccination related pain: comparison of two injection techniques. The Indian Journal of Pediatrics. 2014 Dec 1; 81 (12): 1327-31.
[47]	Ipp M, Taddio A, Sam J, Gladbach M, Parkin PC. Vaccine-related pain: randomised controlled trial of two injection techniques. Archives of disease in childhood. 2007 Dec 1; 92 (12): 1105-8.
[48]	Committee on Infectious Diseases. Active immunization: report of the Committee on Infectious Diseases, In: Pickering LK, ed. Red book. 27th ed. Elk Grove Village, IL: American Academy Paediatrics, 2006: 9-51.
[49]	Ipp M, Sam J, Parkin P. Needle aspiration and intramuscular immunization. Arch Pediatr Adolesc Med 2006; 160: 451.
[50]	Ipp M, Goldbach M, Greenberg S, et al. Effect of needle change and air bubble in syringe on minor adverse reactions associated with DPT-polio immunization in infants. Pediatr Infect Dis 1990; 9: 291-2.
[51]	Sisson H. Aspirating during the intramuscular injection procedure; a systematic literature review. J Clin Nurs 2015 sep; 24 (17-18): 2368-75.

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APA Style

Mitesh Chawda, Guruveerajeyasingh Malini, Subodh Kumar Saha, Shantilal Chawda, Ganpat Jha, et al. (2019). Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques. American Journal of Pediatrics, 5(3), 133-141. https://doi.org/10.11648/j.ajp.20190503.19

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ACS Style

Mitesh Chawda; Guruveerajeyasingh Malini; Subodh Kumar Saha; Shantilal Chawda; Ganpat Jha, et al. Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques. Am. J. Pediatr. 2019, 5(3), 133-141. doi: 10.11648/j.ajp.20190503.19

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AMA Style

Mitesh Chawda, Guruveerajeyasingh Malini, Subodh Kumar Saha, Shantilal Chawda, Ganpat Jha, et al. Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques. Am J Pediatr. 2019;5(3):133-141. doi: 10.11648/j.ajp.20190503.19

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@article{10.11648/j.ajp.20190503.19,
  author = {Mitesh Chawda and Guruveerajeyasingh Malini and Subodh Kumar Saha and Shantilal Chawda and Ganpat Jha and Ashish Wanare and Ravi Prakash Pandey and Hitav Someshwar},
  title = {Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques},
  journal = {American Journal of Pediatrics},
  volume = {5},
  number = {3},
  pages = {133-141},
  doi = {10.11648/j.ajp.20190503.19},
  url = {https://doi.org/10.11648/j.ajp.20190503.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190503.19},
  abstract = {Background: Immunisations is one of commonest cause of iatrogenic pain among healthy infants though several authorities have recommended that no aspiration is required before injecting into the anterolateral thigh, it is still a commonly followed procedure. Method: 202 healthy infants of either sex of age group 6 weeks to 6 months receiving routine intramuscular pentavalent vaccine were selected randomly by computer generated numbers and divided into two groups “standard” group and “pragmatic” group with 101 infants in each group. Two methods of vaccination conventional and pragmatic are used. In both cases pre vaccination and post vaccination pain was accessed by using FLACC scale and modified behavioural pain scale as well as cry time was noted. Results: The pre vaccination mean FLACC score in standard group is 2.07 (±1.17) while that in pragmatic group is 1.79 (±1.28). Post vaccination mean FLACC score in standard group is 8.5 (±0.82) while that in pragmatic group is 7.79 (±1.25). The pre vaccination mean MBPS in both standard & pragmatic group is 2.16 (±1.07). The post vaccination mean MBPS in standard group is 8.13 while that in pragmatic group is 8.16. Conclusions: Our study revealed that there was significant difference in perception of pain among the two groups. The Pragmatic group being a better technique for vaccination.},
 year = {2019}
}

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TY  - JOUR
T1  - Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques
AU  - Mitesh Chawda
AU  - Guruveerajeyasingh Malini
AU  - Subodh Kumar Saha
AU  - Shantilal Chawda
AU  - Ganpat Jha
AU  - Ashish Wanare
AU  - Ravi Prakash Pandey
AU  - Hitav Someshwar
Y1  - 2019/08/06
PY  - 2019
N1  - https://doi.org/10.11648/j.ajp.20190503.19
DO  - 10.11648/j.ajp.20190503.19
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 133
EP  - 141
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20190503.19
AB  - Background: Immunisations is one of commonest cause of iatrogenic pain among healthy infants though several authorities have recommended that no aspiration is required before injecting into the anterolateral thigh, it is still a commonly followed procedure. Method: 202 healthy infants of either sex of age group 6 weeks to 6 months receiving routine intramuscular pentavalent vaccine were selected randomly by computer generated numbers and divided into two groups “standard” group and “pragmatic” group with 101 infants in each group. Two methods of vaccination conventional and pragmatic are used. In both cases pre vaccination and post vaccination pain was accessed by using FLACC scale and modified behavioural pain scale as well as cry time was noted. Results: The pre vaccination mean FLACC score in standard group is 2.07 (±1.17) while that in pragmatic group is 1.79 (±1.28). Post vaccination mean FLACC score in standard group is 8.5 (±0.82) while that in pragmatic group is 7.79 (±1.25). The pre vaccination mean MBPS in both standard & pragmatic group is 2.16 (±1.07). The post vaccination mean MBPS in standard group is 8.13 while that in pragmatic group is 8.16. Conclusions: Our study revealed that there was significant difference in perception of pain among the two groups. The Pragmatic group being a better technique for vaccination.
VL  - 5
IS  - 3
ER  -

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Author Information

Mitesh Chawda

Resident Secondary DNB Pediatrics, Jawaharlal Nehru Hospital & Research Center, Bhilai, Chhattisgarh, India
Guruveerajeyasingh Malini

Department of Pediatrics, Jawaharlal Nehru Hospital & Research Center, Bhilai, Chhattisgarh, India
Subodh Kumar Saha

Department of Pediatrics, Jawaharlal Nehru Hospital & Research Center, Bhilai, Chhattisgarh, India
Shantilal Chawda

Pediatrics, Rt. Chief Medical & Health Officer, Govt. of Chhattisgarh, Korea, Chhattisgarh, India
Ganpat Jha

Resident Secondary DNB Pediatrics, Jawaharlal Nehru Hospital & Research Center, Bhilai, Chhattisgarh, India
Ashish Wanare

Resident Secondary DNB Pediatrics, Jawaharlal Nehru Hospital & Research Center, Bhilai, Chhattisgarh, India
Ravi Prakash Pandey

Resident Secondary DNB Pediatrics, Jawaharlal Nehru Hospital & Research Center, Bhilai, Chhattisgarh, India
Hitav Someshwar

Resident Neurophysiotherapy, K. J Somaiya College of Physiotherapy, Mumbai, Maharashtra, India

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APA Style

Mitesh Chawda, Guruveerajeyasingh Malini, Subodh Kumar Saha, Shantilal Chawda, Ganpat Jha, et al. (2019). Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques. American Journal of Pediatrics, 5(3), 133-141. https://doi.org/10.11648/j.ajp.20190503.19

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ACS Style

Mitesh Chawda; Guruveerajeyasingh Malini; Subodh Kumar Saha; Shantilal Chawda; Ganpat Jha, et al. Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques. Am. J. Pediatr. 2019, 5(3), 133-141. doi: 10.11648/j.ajp.20190503.19

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AMA Style

Mitesh Chawda, Guruveerajeyasingh Malini, Subodh Kumar Saha, Shantilal Chawda, Ganpat Jha, et al. Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques. Am J Pediatr. 2019;5(3):133-141. doi: 10.11648/j.ajp.20190503.19

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@article{10.11648/j.ajp.20190503.19,
  author = {Mitesh Chawda and Guruveerajeyasingh Malini and Subodh Kumar Saha and Shantilal Chawda and Ganpat Jha and Ashish Wanare and Ravi Prakash Pandey and Hitav Someshwar},
  title = {Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques},
  journal = {American Journal of Pediatrics},
  volume = {5},
  number = {3},
  pages = {133-141},
  doi = {10.11648/j.ajp.20190503.19},
  url = {https://doi.org/10.11648/j.ajp.20190503.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20190503.19},
  abstract = {Background: Immunisations is one of commonest cause of iatrogenic pain among healthy infants though several authorities have recommended that no aspiration is required before injecting into the anterolateral thigh, it is still a commonly followed procedure. Method: 202 healthy infants of either sex of age group 6 weeks to 6 months receiving routine intramuscular pentavalent vaccine were selected randomly by computer generated numbers and divided into two groups “standard” group and “pragmatic” group with 101 infants in each group. Two methods of vaccination conventional and pragmatic are used. In both cases pre vaccination and post vaccination pain was accessed by using FLACC scale and modified behavioural pain scale as well as cry time was noted. Results: The pre vaccination mean FLACC score in standard group is 2.07 (±1.17) while that in pragmatic group is 1.79 (±1.28). Post vaccination mean FLACC score in standard group is 8.5 (±0.82) while that in pragmatic group is 7.79 (±1.25). The pre vaccination mean MBPS in both standard & pragmatic group is 2.16 (±1.07). The post vaccination mean MBPS in standard group is 8.13 while that in pragmatic group is 8.16. Conclusions: Our study revealed that there was significant difference in perception of pain among the two groups. The Pragmatic group being a better technique for vaccination.},
 year = {2019}
}

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TY  - JOUR
T1  - Vaccination Related Pain: Randomized Controlled Trial, Comparison of Pain of Two Injection Techniques
AU  - Mitesh Chawda
AU  - Guruveerajeyasingh Malini
AU  - Subodh Kumar Saha
AU  - Shantilal Chawda
AU  - Ganpat Jha
AU  - Ashish Wanare
AU  - Ravi Prakash Pandey
AU  - Hitav Someshwar
Y1  - 2019/08/06
PY  - 2019
N1  - https://doi.org/10.11648/j.ajp.20190503.19
DO  - 10.11648/j.ajp.20190503.19
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 133
EP  - 141
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20190503.19
AB  - Background: Immunisations is one of commonest cause of iatrogenic pain among healthy infants though several authorities have recommended that no aspiration is required before injecting into the anterolateral thigh, it is still a commonly followed procedure. Method: 202 healthy infants of either sex of age group 6 weeks to 6 months receiving routine intramuscular pentavalent vaccine were selected randomly by computer generated numbers and divided into two groups “standard” group and “pragmatic” group with 101 infants in each group. Two methods of vaccination conventional and pragmatic are used. In both cases pre vaccination and post vaccination pain was accessed by using FLACC scale and modified behavioural pain scale as well as cry time was noted. Results: The pre vaccination mean FLACC score in standard group is 2.07 (±1.17) while that in pragmatic group is 1.79 (±1.28). Post vaccination mean FLACC score in standard group is 8.5 (±0.82) while that in pragmatic group is 7.79 (±1.25). The pre vaccination mean MBPS in both standard & pragmatic group is 2.16 (±1.07). The post vaccination mean MBPS in standard group is 8.13 while that in pragmatic group is 8.16. Conclusions: Our study revealed that there was significant difference in perception of pain among the two groups. The Pragmatic group being a better technique for vaccination.
VL  - 5
IS  - 3
ER  -

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