Efficacy and safety of vapocoolant spray for vascular puncture in children and adults: A systematic review and meta-analysis

Lan Wang, Liu Fang, Yang Zhou, Xiaofeng Fang, Jiang Liu, Guiyu Qu, Lan Wang, Liu Fang, Yang Zhou, Xiaofeng Fang, Jiang Liu, Guiyu Qu

Abstract

Objective: The aim was to evaluate the effectiveness and safety of the vapocoolants for vascular puncture in children and adults.

Method: The search was carried out in PubMed, Web of Science, Embase and The Cochrane Library, from inception to March 2022. Randomized controlled trials comparing vapocoolants to control conditions for participants received intravenous cannulation or arterial puncture were included. Two reviewers independently performed selection of studies, data extraction, and assessment of risk of bias. The analysis was performed using fixed or random-effects model with mean differences or standardized mean difference and risk ratios.

Results: A total of 25 studies involving 3143 participants were included. Compared with control conditions, vapocoolants may not decrease the pain of patients with arterial puncture (SMD = -0.36, 95% CI = -0.92 to -0.19, P = 0.20), but may more effectively relieve pain for adults received vein puncture (SMD = -0.65, 95% CI = -0.85 to -0.45, P < 0.00001). The application of vapocoolant increased the procedural difficulty of medical personnel (RR = 2.49, 95% CI = 1.62 to 3.84, P<0.000 1) and participants were more willing to use the spray in the future (RR = 1.88, 95% CI = 1.34 to 2.64, P = 0.0002). There was no significant difference for the first attempt success rate of the procedure and the occurrence of adverse events.

Conclusions: Vapocoolant spray may relieve pain in adults received vein puncture and cannot cause severe side effects, but is ineffective in children. It also had no effect on patients with arterial puncture. In addition, the application of spray increases procedural difficulties for medical professionals, but does not decrease first attempt success rate, and many patients would like to use the spray again for pain relief in the future. Thus, more rigorous and large-scale studies are needed to determine its effectiveness in vascular access.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright: © 2023 Wang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Figures

Fig 1. Study selection.
Fig 1. Study selection.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Iterns for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097For more information, visitwww.prisma-statement.org.
Fig 2. Summary of risk of bias.
Fig 2. Summary of risk of bias.
Fig 3. Forest plot of pain scores…
Fig 3. Forest plot of pain scores during artery puncture.
Fig 4. Forest plot of pain scores…
Fig 4. Forest plot of pain scores during intravenous cannulation.
Fig 5. Subgroup analysis of pain scores…
Fig 5. Subgroup analysis of pain scores during intravenous cannulation: Vapocoolants in children vs adults.
Fig 6. Subgroup analysis of pain scores…
Fig 6. Subgroup analysis of pain scores during intravenous cannulation: Vapocoolants spray distance ≤10cm vs >10cm.
Fig 7. Subgroup analysis of pain scores…
Fig 7. Subgroup analysis of pain scores during intravenous cannulation: Vapocoolants spray time ≤5s vs >5s.
Fig 8. Subgroup analysis of pain scores…
Fig 8. Subgroup analysis of pain scores during intravenous cannulation: Vapocoolants type ethyl chloride vs not ethyl chloride.
Fig 9. Forest plot of adverse effect.
Fig 9. Forest plot of adverse effect.
Fig 10. Forest plot of patient’s attitude.
Fig 10. Forest plot of patient’s attitude.
Fig 11. Forest plot of first attempt…
Fig 11. Forest plot of first attempt success rate.
Fig 12. Forest plot of procedural difficulty.
Fig 12. Forest plot of procedural difficulty.

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