Is tablet-based interactive distraction effective on pain and anxiety during circumcision in children? A randomized controlled trial

Elif Gezginci, Derya Suluhan, Mehmet Bahadir Caliskan, Elif Gezginci, Derya Suluhan, Mehmet Bahadir Caliskan

Abstract

Objective: Distraction is a nonpharmacological method commonly used during painful procedures in children. However, there are a few studies investigating the effectiveness of active distraction on pain and anxiety in children during circumcision. The purpose of this study was to evaluate the effectiveness of tablet-based interactive distraction on pain and anxiety in children during circumcision.

Material and methods: To evaluate how tablet distraction could improve children's outcomes during circumcision, a single-center, nonblinded, randomized controlled, parallel group trial research design was employed. In this study, 35 children were included in tablet distraction group, which have a control group (n ¼ 35). The primary outcome measure was the Numeric Rating Scale for pain. Secondary outcome measure was the State- Trait Anxiety Scale for Children, and other outcome variables were physiological parameters and satisfaction levels.

Results: During and after the surgical procedure, pain scores (P < .001, P < .001, respectively) and pulse rates (P < .001, P < .001, respectively) were significantly lower in the tablet distraction group, whereas O2 saturation was higher than the control group (P < .001, P < .001, respectively). After the procedure, the anxiety scores were significantly lower in the tablet distraction group (P < .001), whereas the satisfaction scores were higher than control group (P < .001).

Conclusion: This study concluded that the use of tablet distraction during circumcision has a positive effect on children's pain, anxiety, satisfaction levels, and physiological parameters.

Conflict of interest statement

Conflict of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
CONSORT flow diagram.

References

    1. WHO and UNAIDS. Neonatal and Child Male Circumcision: A Global Review . Geneva: WHO and UNAIDS, 2010: 1–103..
    1. Polat F, Tuncel A, Balci al. Comparision of local anesthetic effects of lidocaine versus tramadol and effect of child anxiety on pain level in circumcision procedure. J Pediatr Urol . 2013;9:670–674.. 10.1016/j.jpurol.2012.07.022)
    1. Morris BJ, Krieger JN, Klausner JD. CDC’s male circumcision recommendations represent a key public health measure. Glob Health Sci Pract . 2017;5:(1):15–27.. 10.9745/GHSP-D-16-00390)
    1. American Academy of Pediatrics. Circumcision policy statement. Pediatrics . 2012;130:585–586..
    1. Wilson-Smith EM. Procedural pain management in neonates, infants and children. Rev Pain . 2011;5:4–12.. 10.9745/GHSP-D-16-00390) 10.1177/204946371100500303)
    1. Olsen K, Weinberg E. Pain-less practice: Techniques to reduce procedural pain and anxiety in pediatric acute care. Clin Pediatr Emerg Med . 2017;18:32–41.. 10.1016/j.cpem.2017.01.007)
    1. Nilsson S, Enskär K, Hallqvist C, Kokinsky E. Active and passive distraction in children undergoing wound dressings. J Pediatr Nurs . 2013;28:158–166.. 10.1016/j.pedn.2012.06.003)
    1. Attar RH, Baghdadi ZD. Comparative efficacy of active and passive distraction during restorative treatment in children using an iPad versus audiovisual eyeglasses: A randomised controlled trial. Eur Arch Paediatr Dent . 2015;16:1–8.. 10.1007/s40368-014-0136-x)
    1. Hussein HA. Effect of active and passive distraction on decreasing pain associated with painful medical procedures among school aged children. WJNS . 2015;1:13–23..
    1. Inan G, Inal S. The impact of 3 different distraction techniques on the pain and anxiety levels of children during venipuncture. Clin J Pain . 2019;35:140–147.. 10.1097/AJP.0000000000000666)
    1. Liguori S, Stacchini M, Ciofi D, Olivini N, Bisogni S, Festini F. Effectiveness of an app for reducing preoperative anxiety in children a randomized clinical trial. JAMA Pediatr . 2016;170:1–6.. 10.1001/jamapediatrics.2016.0533)
    1. Buyuk ET, Odabasoglu E, Uzsen H, Koyun M. The effect of virtual reality on children’s anxiety, fear, and pain levels before circumcision. J Pediatr Urol . 2021;S1477-5131:(21):00215-1.
    1. Yesilot SB, Ciftci H, Ozcelik Z. The effect of virtual reality on mothers’ anxiety during children’s circumcision: A randomized controlled study. Int J Nurs Pract . 2021;27:(4):e12906. 10.1111/ijn.12906)
    1. Suzan ÖK, Şahin ÖÖ, Baran Ö. Effect of puppet show on children’s anxiety and pain levels during the circumcision operation: A randomized controlled trial. J Pediatr Urol . 2020;16:(4):490.e1-490.e8. 10.1016/j.jpurol.2020.06.016)
    1. Spielberger CD. Manual for the State-Trait Anxiety Inventory for Children . Palo Alto: Consulting Psychologists Press, 1973.
    1. Özusta HŞ. Çocuklar için durumluk-sürekli kaygı envanteri uyarlama, geçerlik ve güvenirlik çalışması. TPD . 1995;10:32–44..
    1. Uman LS, Chambers CT, McGrath PJ, Kisely S. A systematic review of randomized controlled trials examining psychological interventions for needle-related procedural pain and distress in children and adolescents: An abbreviated cochrane review. J Pediatr Psychol . 2008;33:842–854.. 10.1093/jpepsy/jsn031)
    1. Oakes LL. Compact Clinical Guide to Infant and Child Pain Management . New York: Springer Publishing Company, 2011: 3–54..
    1. Karakaya A, Gözen D. The effect of distraction on pain level felt by school-age children during venipuncture procedure-randomized controlled trial. Pain Manag Nurs . 2016;17:(1):47–53.. 10.1016/j.pmn.2015.08.005)
    1. Joyce BA, Keck JF, Gerkensmeyer J. Evaluation of pain management interventions for neonatal circumcision pain. J Pediatr Health Care . 2001;15:105–114.. 10.1016/S0891-5245(01)45632-X)

Source: PubMed

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