title: Reduced pain of intraarticular hyaluronate injection with the reciprocating procedure device.
abstract: BACKGROUND
  Greater than 50% of patients report significant pain with intraarticular injection of hyaluronate. The reciprocating procedure device (RPD), also known the reciprocating syringe, has 2 plungers that reciprocate with each other, permitting one-handed operation. The RPD increases physician control of the needle and is proposed to reduce patient pain during syringe procedures.
  
  
  OBJECTIVE
  To determine in a randomized controlled trial whether the RPD induces less pain than the traditional syringe during intraarticular hyaluronate therapy for the knee.
  
  
  METHODS
  Eighty intraarticular injection procedures of the knee were randomized to either the conventional syringe or the RPD using hyaluronate sodium derivative (Hylan G-F-20). Outcome measures included physician's estimate of pain, patient pain (Visual Analogue Pain Scale [VAPS]), procedure duration, operator satisfaction, complications, and response to the injected medication.
  
  
  RESULTS
  Patients reported 85% more pain than physicians estimated. Fifty-one percent (19/37) of subjects experienced moderate to severe pain with the conventional syringe, while only 14% (6/43) experienced pain with the RPD. The RPD reduced pain scores (RPD VAPS score: 2.12 +/- 2.15; conventional syringe VAPS score: 4.22 +/- 3.25; P < 0.001), reduced procedure time (RPD: 1.34 +/- 1.09, conventional syringe: 1.90 +/- 1.35 minutes, P < 0.001), and improved physician satisfaction (RPD VASS Score: 9.02 +/- 0.80, conventional syringe 5.69 +/- 1.33, P < 0.001).
  
  
  CONCLUSIONS
  Patients have considerably more pain with intraarticular needle introduction and injectable hyaluronate therapy than physicians estimate. The RPD reduces patient pain, reduces procedure time, and improves needle introduction compared with the conventional syringe for hyaluronate injection therapy for the knee.
authors.affiliation: Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Nunez
authors.forename: Hilda T
authors.initials: HT
authors.lastname: Draeger
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Rivero
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Kettwich
authors.forename: Wilmer L
authors.initials: WL
authors.lastname: Sibbitt
authors.forename: Arthur D
authors.initials: AD
authors.lastname: Bankhurst
mesh_terms: D000328:Adult; D001672:Biocompatible Materials / Q000008:administration & dosage*; D004867:Equipment Design; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D007270:Injections, Intra-Articular / Q000009:adverse effects / Q000295:instrumentation*; D007592:Joint Diseases / Q000188:drug therapy; D007719:Knee Joint; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D013594:Syringes; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C049816:hylan; D006820:Hyaluronic Acid