Appraisal of Systemic Review
Appraisal of Systemic Review
The purpose of this systemic review was to determine whether vapocoolant sprays could reduce pain due to IV cannulation in children and adults. The systematic review ought to examine the available literature concerning the analgesic effectiveness of the vapocoolants for the two groups under study. Previous research on vapocoolants in the reduction of pain from venipuncture has shown varying results. The databases that were searched include MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Central Register of Trials (CCRT). To quickly retrieve relevant information, keywords that helped to gather information from the search engines included vapocoolant, pain, cannulation, and pain. Two authors did the examination of the titles and abstracts that were obtained. In the pursuit through the databases, a total of 1195 papers were identified. After the identification, about 196 duplicates were found and removed, thus remaining with about 999 different studies for review. Besides, there was the retrieval of 36 full papers for close analysis, whereby 24 of them were executed.
The PICO question for the study was; for adults and children entering the study, is the use of vapocoolant spray as effective as the placebo or no treatment in reducing pain resulting from IV cannulation or venipuncture?
There were three main findings from the study that make the study an evidence-based procedure are outlined in the findings. First, we found that pain from venipuncture and venous cannulation after application of vapocoolant was not statistically different from the placebo, and there was clear, moderate heterogeneity. Quantitatively, two comparisons demonstrated point approximations in favor of the reduction of pain from the application of vapocoolant. However, only a single one appeared to be applicable or considerably statistically significant. One of the comparisons used the saline spray as the placebo, whereas the other four used alcohol spray.
Secondly, there was a posthoc meta-analysis, which covered all the studies with children and conducted because of the small number of children and research in each of the two meta-analyses reported. There was combination of data from all of the four studies, and the results showed not statistical variance between the vapocoolant and the comparison groups, which included placebo or no treatment (Mary-Ellen, Sarah, Vibhuti & Anna, 2014). Here, there was clear evidence of considerable heterogeneity. Apart from the single research with the midazolam in both the control groups and vapocoolant there was also no statistical variance between the groups.
Finally, there was an evaluation of vapocoolants about the placebo in two studies involving 289 individuals. No statistical difference was found between the pain after pretreatment with a vapocoolant and the placebo, with clear evidence of considerable heterogeneity. Qualitatively, just like the other two findings above, we find that both of them demonstrated point approximations in favor of the reduction of pain from the application of vapocoolant, however, only one was statistically applicable. Of the two studies, one pretreated all the subjects with nitrous oxide; on exclusion in a posthoc review, the single study demonstrated a statistically lower pain score in the group of vapocoolant in comparison with the placebo. All there three findings help in answering the question of whether vapocoolants was effective in reducing pain from venipuncture and venous cannulation in both children together with adults.
Number of Levels of evidence for consideration
There are three levels of evidence in total to consider, which are:
Level 1: A report of a single research stud
Level II: A summary of multiple research studies
Level III: Non-research evidence
I consider level II as being the strongest because it is the most comprehensive because it is a collection of other studies, and them making comparisons to come up with an inclusive conclusion and recommendations.
The basis of this systematic review is a summary of multiple research studies in the level II evidence above. The author searched through various databases using some keywords that are relevant to the topic and found several titles, abstracts and full papers, whose findings were reviewed and compared to deduce own conclusions and recommendations. Through evaluation of the results for the effectiveness of the vapocoolants in reducing pain found them ineffective in easing of pain from venipuncture and IV cannulation in children (Mary-Ellen, Sarah, Vibhuti and Anna, 2014). However, in adults, vapocoolant appeared to work when compared to not treatment even though the effects were not serious in reducing the pain after application. As much as they seem to be effective in adults to some extent, the authors established that they were unsuitable for routine use in both the adults and children.
Use vapocoolants on children and adults who are undergoing venipuncture and IV cannulation.
During their regular hospital visits, Children and adults go through IV cannulation in the emergency departments to ease the pain. If the pain is not reduced, it results in the patient, particularly children being uncooperative, unsuccessful processes (more number of attempts), prolonged period of the operation, and care discontent for both patients and care providers. Reduction of pain can occur through pharmacologic and behavioral remedies, such as parental availability, techniques of distraction, systematic and tropical anesthetics, however, most of these preparations are not applicable in the non-elective settings for their time unconsciousness (Anesiva, 2008). Nevertheless, this can be solved by new methods of delivery and novel medication compositions (Kleiber, Sorenson, & Whiteside 2002). As the study reports, vapocoolant sprays are good alternatives to topical anesthetics in adults. According to the finding, vapocoolant sprays do not reduce pain due to IV cannulation in children but it does in the adults. Therefore, I think it should only be used to reduce pain in the adults in emergencies because they appear to work within seconds of application. As the authors have found out in their study, it should not be used routinely, as it does not work very effectively.
Anesiva, In., (2008). “Urgent: Zingo non-safety recall & market withdrawal.” South San Francisco, CA.
Kleiber C, Sorenson M, Whiteside K, et al. (2002). “Topical anesthetics for intravenous insertion in children: a randomized equivalency study.” Pediatrics;110:758-6
Mary-Ellen H, Sarah S, Vibhuti S and Anna, T. (2014). A Systematic Review of Vapocoolants for Reducing Pain From Venipuncture and Venous Cannulation in Children and Adults. The journal of Emergency Medicine, vol. -, no. -, pp. 1–14.