title: Evaluating the efficacy of the valsalva maneuver on venous cannulation pain: a prospective, randomized study.
abstract: Pain associated with venous cannula is a distressing symptom. We evaluated the efficacy of the Valsalva maneuver on pain associated with venous cannulation. Seventy-five adults, ASA physical status I and II, either sex, undergoing elective surgery, were included in this study. Patients were randomized into 3 groups of 25 each. Group I (C): control; Group II (V): blew into sphygmomanometer tubing and raised the mercury column up to 30 mm Hg for 20 s; Group III (B): pressed a rubber ball. Twenty seconds later, peripheral venous cannulation was performed. Venous cannulation pain was graded using a 4-point scale: 0-3, where 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain, and visual analog scale of 0-10, where 0 = no pain and 10 = worst imaginable pain. A significant reduction in the incidence of pain was observed in the Valsalva group: 18 of 25 (72%) patients, whereas 25 of 25 (100%) experienced pain in the other two groups (P < 0.001). A significant reduction in the severity of pain, number of patients in whom one needed to make the vein prominent before cannulation, and the time taken for the same were observed in the Valsalva group (P < 0.001).
  
  
  CONCLUSIONS
  Venous cannulation is a necessary step for safe anesthesia administration; however, the pain associated with it is sometimes very distressing. We observed that the Valsalva maneuver performed at the time of venous cannulation greatly decreases this pain.
authors.affiliation: *Department of Anesthesia and ‡Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; and †Sree Chitra Tirunal Institute for Medical Sciences &Technology, Trivandrum, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Agarwal
authors.forename: P K
authors.initials: PK
authors.lastname: Sinha
authors.forename: Manish
authors.initials: M
authors.lastname: Tandon
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dhiraaj
authors.forename: Uttam
authors.initials: U
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control*; D018962:Phlebotomy / Q000009:adverse effects*; D011446:Prospective Studies; D014636:Valsalva Maneuver