title: Reducing the pain of intramuscular benzathine penicillin injections in the rheumatic fever population of Counties Manukau District Health Board.
abstract: OBJECTIVE
  To evaluate the effectiveness of lignocaine and a vibrating device with cold pack (Buzzy) for pain management of intramuscular (IM) benzathine penicillin injections in the rheumatic fever (RF) population of Counties Manukau District Health Board (CMDHB).
  
  
  METHODS
  Four hundred and five RF patients receiving four weekly injections in the CMDHB region were offered 0.25 mL of lignocaine 2% and Buzzy for pain management of their injections. The lignocaine was mixed in with the benzathine penicillin prior to administration. A pre and post survey assessed pain scores during, 2-min and 1-h post administration and the following day. Questions assessing fear were also included.
  
  
  RESULTS
  In total 49% of patients responded to the survey. There were 118 surveys paired pre and post intervention. Pain at injection delivery and fear scores were higher for participants ≤13 years of age. Overall pain scores were significantly reduced over all four time points. There was also a significant reduction in fear of the injections. Lignocaine and Buzzy resulted in a greater reduction in pain than lignocaine alone, only when the injection was being administered to those ≤13 years. After five months, a file audit showed that 66% of all RF patients of CMDHB were choosing to use lignocaine and 43% were choosing to use Buzzy. In total, 71% of all RF patients were choosing one or both of these analgesic interventions.
  
  
  CONCLUSIONS
  This study demonstrates a clinically important reduction in the subjective experience of pain when two analgesic interventions were offered with IM delivery of benzathine penicillin. These pain reduction strategies have been popular in the RF population of CMDHB with a 71% uptake and a corresponding reduction in pain and fear.
authors.affiliation: Kidz First Children's Hospital, Auckland, New Zealand; Whirinaki Child and Adolescent Mental Health Service, Auckland, New Zealand.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Russell
authors.forename: Ross
authors.initials: R
authors.lastname: Nicholson
authors.forename: Rajeshni
authors.initials: R
authors.lastname: Naidu
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005239:Fear; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects*; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D010146:Pain / Q000517:prevention & control*; D059408:Pain Management; D010401:Penicillin G Benzathine / Q000009:adverse effects / Q000627:therapeutic use*; D012213:Rheumatic Fever / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D010401:Penicillin G Benzathine
keywords: benzathine penicillin; procedural pain management; rheumatic fever