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Abstract

Intravenous cannulation is the most frequently used procedures in the wards, casualty and in preoperative preparation. It is a very painful and stressful procedure, thus emotions may become exaggerated at times, triggering vasovagal reaction. Patient's anxiety and fears concerning needles are real and may even prevent them from seeking health care.Our Aim was to estimate the level of pain perception after intravenous cannulation using Visual analogue pain scale among adult males and females and to study the gender variation in perception of pain.The study was conducted after ethical clearance, with a total of 100 subjects, informed consent was taken. Immediately after the intravenous cannulation using 20 gauge intravenous cannula the subjective pain was assessed by using Visual Analogue pain scale (VAS) on 0 (No pain) – 10 (Max pain). Results thus obtained were analyzed by Pearson Chi Square test(X 2).Pain perception was moderate to severe (5-10) in 64% of females as compared to 12% in males. There was significant increase in pain perception in females compared to males (X 2 = 31.84, p<.001).
The Internet Journal of Anesthesiology 2011 : Volume 28 Number 1
Gender Variation In Pain Perception After
Intravenous Cannulation In Adults
Jagadamba.A
Department Of Physiology
Sri Devaraj Urs Medical College
Kolar
Karthiyanee Kutty
Department of Physiology
Sri Devaraj Urs Medical College
Kolar
Vinutha Shankar M.S
Department of Physiology
Sri Devaraj Urs Medical College
Kolar
Nachal Annamalai
Department of Physiology
Sri Devaraj Urs Medical College
Kolar
Ravi Madhusudhana
Associate Professor
Department Of Anesthesiology And Intensive Care
Sri Devaraj Urs Medical College
Kolar
Citation: J. A. , K. Kutty, V. Shankar, N. Annamalai & R. Madhusudhana : Gender Variation In Pain Perception After Intravenous
Cannulation In Adults. The Internet Journal of Anesthesiology. 2011 Volume 28 Number 1
Keywords: Gender | Pain | Intravenous cannulation | Visual analog pain scale.
Abstract
Intravenous cannulation is the most frequently used procedures in the wards, casualty and in preoperative
preparation. It is a very painful and stressful procedure, thus emotions may become exaggerated at times, triggering
vasovagal reaction. Patients anxiety and fears concerning needles are real and may even prevent them from seeking
health care.Our Aim was to estimate the level of pain perception after intravenous cannulation using Visual analogue
pain scale among adult males and females and to study the gender variation in perception of pain.The study was
conducted after ethical clearance, with a total of 100 subjects, informed consent was taken. Immediately after the
intravenous cannulation using 20 gauge intravenous cannula the subjective pain was assessed by using Visual
Analogue pain scale (VAS) on 0 (No pain) 10 (Max pain). Results thus obtained were analyzed by Pearson Chi
Square test(X2).Pain perception was moderate to severe (5-10) in 64% of females as compared to 12% in males.
There was significant increase in pain perception in females compared to males (X2 = 31.84, p<.001).
Background
Pain is one of the most common widely under-treated health problems. As a basic scientific definition, pain is a
sensation caused by some type of noxious stimulus. From the behavioural aspect, pain is a pattern of responses that
function to protect an individual from harm.
The International Association for the Study of Pain (IASP) defines pain as an unpleasant, subjective sensory and
emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
Untreated and inadequately treated pain causes suffering.
Almost every tissue found in the human body contains pain receptors, called nociceptors. It has been estimated that
the skin may contain as many as 1,300 nociceptors in one square inch. These nociceptors respond to thermal,
chemical, and mechanical stimuli through a-delta, C, and a-beta fibres. The a-delta receptors contain small,
myelinated fibres that rapidly transmit acute, sharp pain signals from the peripheral nerves to the spinal cord. C
receptors have larger, unmyelinated fibres that transmit pain at a slower rate and are commonly associated with long
lasting, burning pain sensation.
Intravenous cannulation is the most frequently used procedure in the wards, casualty and in preoperative
preparation. It is a very painful and stressful procedure, thus emotions may become exaggerated at times, triggering
vasovagal reaction. Patients anxiety and fears concerning needles are real and may even prevent them from seeking
health care.
Aims & Objectives
To estimate the level of pain perception after intravenous cannulation using Visual analogue pain scale among adult
males and females.
To study the gender variation in perception of pain.
Methods And Materials
The study was conducted with a total of 100 subjects, after obtaining Ethical clearance and informed consent. The age
group included 18 to 50 years of either sex and subjects were taken from general wards and preoperative wards.
Immediately after the intravenous cannulation by a trained person, with a single attempt, using 20 gauge IV cannula,
the subjective pain was assessed by asking the person to give a score depending on the intensity of pain he/she
experienced during cannulation- using Visual Analogue pain scale (VAS) on 0 (No pain) 10 (Max pain).In case of
illiterate patients the Faces of pain scale was used and 0- 5 scale was doubled to match the VAS scores.
Results thus obtained were analyzed by Pearson Chi Square test (X2).
The Faces of Pain Scale
Results
VAS.GR * SEX Cross tabulation
Chi-Square Tests
Discussion
In our study Pain perception was moderate to severe (5-10) in 64% of females as compared to 12% in males and was
statistically significant.
Various strategies have been investigated that address the pain associated with intravenous cannula insertion. A
topical preparation of local anaesthetics that can be applied to intact skin is one such option, Gajraj, NM etal, who
evaluated the minimal effective onset time of EMLA®cream required to decrease intravenous cannulation pain in
adults reported that pain associated with intravenous cannulation, was significantly less after only five minutes of
EMLA®cream.1
A number of studies have demonstrated a higher prevalence of chronic pain states and greater pain sensitivity among
women compared with men. Pain sensitivity is thought to be mediated by sociocultural, psychological, and biological
factors.2
Although differences in pain sensitivity between women and men are partly attributable to social conditioning and to
psychosocial factors, many laboratory studies of humans have described sex differences in sensitivity to noxious
stimuli, suggesting that biological mechanisms underlie such differences. In addition, sex hormones influence pain
sensitivity; pain threshold and pain tolerance in women vary with the stage of the menstrual cycle. Imaging studies of
the brain have shown differences between men and women in the spatial pattern and intensity of response to acute
pain.3
Woodrow, Friedman et al found that males were able to tolerate more pain than females. Feine, Bushnell etal reported
women had higher pain scores. Woodrow, Friedman, Siegelaub, et al found that males were able to tolerate more pain
than females. 4
Research indicates that women experience greater clinical pain, suffer greater pain-related distress, and show
heightened sensitivity to experimentally induced pain compared with men. Many times going the extra mile by
implementing treatments that provide patient comfort and allay anxiety will make the difference in patient
satisfaction.5,6.
Conclusion
In our study there was significant increase in pain perception in females compared to males (X2 = 31.84, p<0.001).
Further research is needed to implement treatments based on gender variation of pain perception that may enable
tailoring of pain treatment to individual characteristics.
Correspondence to
Dr.Ravi.M.
Associate Professor, Department of Anesthesiology and Intensive care, Sri Devaraj Urs Medical
College .Kolar.Karnataka.563101.
Email: ravijaggu@hotmail.com
References
1. Gajraj, NM, Pennant, JH, Watcha, MF. Eutectic Mixture of Local Anesthetics (EMLA®) Cream .Anaesthesiology &
Analgesia. 1994; 78: 574- 583. (s)
2. Zsuzsanna Wiesenfeld, Hallin. Sex differences in pain perception. Gender Medicine .2005; 2 ( 3 ):137-145. (s)
3. Woodrow K M, Friedman G D, Siegelaub A B, et al. Pain tolerance: Differences according to age, sex, race.
Psychosomatic Medicine.1972; 34:548-551. (s)
4. Fiene J S, Bushnell M C, Miron D, et al. Sex differences in perception of noxious heat stimuli. Pain. 1991; 44:255-
262. (s)
5. Anita M. Unruh. Gender variations in clinical pain experience. Pain.1996; 65:123-167. (s)
6. Paller CJ .Sex-based differences in pain perception and treatment. Pain Med. 2009; 10(2): 289-99. (s)
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Article
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