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Manipal Journal of Nursing and Health Sciences

Designation

1.Principal,Govt. College of Nursing, Kollam, Kerala

2. Professor, Govt. Dental College, Thiruvananthapuram, Kerala, India.

3. Professor, School of Public Health, Kerala University of Health Sciences, Kerala, India.

Abstract

Introduction: The administration of intramuscular injection is a common procedure performed by nurses that causes pain to the patient. The way nurses administer injections is one of the factors associated with increased client discomfort. Aspiration has been ingrained in the intramuscular injection procedure, and even though many policies no longer endorse it, it is often frequently taught and used. Injections without aspiration are considered more comfortable for patients. Aspiration in the injection is a controversy concerning its perceived benefits and indications due to a paucity of available data, there is no evidence that this procedure is essential or truly beneficial, and also a contradiction in theory and practice. Numerous research studies have been conducted to assess the effects of various IMI techniques on pain intensity and distress in children. However, a small number of adult studies have been conducted to compare the impact of various injection techniques on pain. The present study aimed to compare the effect of two injection techniques - intramuscular injection with and without aspiration- on pain perception among adult patients.

Methods: A Randomized Controlled Trial was carried out between April 2022 and June 2022 among 484 patients (242 each in the control and experimental group) receiving Inj. Tetanus Toxoid 0.5 mL in deltoid intramuscularly in the Emergency Department of a Tertiary Care Centre, South Kerala, India. The primary outcome was pain measured on the Numerical Pain Rating Scale. Patients in the control group received an intramuscular injection of 0.5ml of Tetanus Toxoid in the deltoid region with aspiration and the experimental group received the same without aspiration. The same investigator gave both injections. The two techniques were randomly allocated and patients were blinded to the injection technique being administered. After each injection, another investigator who had no prior knowledge of which injection technique, assessed the pain, within two minutes of injection using the Numerical Pain Rating Scale. Since the outcome was measured immediately after the injection there was no loss to follow-up.

Results: Baseline variables like age, gender, and body mass index were comparable for both groups. The mean and median Numerical Pain Rating Scale score in the control group (intramuscular injection with aspiration) was 3.36±1.26 and 4 (1) respectively and that in the experimental group (intramuscular injection without spiration) was 1.32±0.51 and1(1). The mean reduction in pain was 2.04 between the groups, which was compared and this was statistically significant (P

Conclusions: The study result showed that intramuscular injection without aspiration was found to be less painful than injection with aspiration. Pain during IMI can be decreased by administering injection without aspiration that can be easily incorporated into clinical practice without added cost or time.

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