10.3389/fpsyg.2012.00132

Vollständiger Abstract

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<h4>Objective</h4>This systematic review and meta-analysis aimed to compare the efficacy of three local physical cooling techniques (ice pack compression, vapor cooling spray, and pre-cooled needles) on pain and ecchymosis after subcutaneous anticoagulant injection, re-examine prior controversies with the latest evidence, and provide evidence-based references for clinical nursing.<h4>Methods</h4>Five electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL) were systematically searched for randomized controlled trials (RCTs) comparing local cold therapy with routine care. Primary outcomes included post-injection pain intensity, ecchymosis incidence, and ecchymosis size.<h4>Results</h4>Ten randomized trials, including seven parallel-group and three randomized within-participant trials, enrolled 807 unique participants. Local cold therapy reduced immediate pain intensity after heparin injection (SMD = -0.64, 95% CI: -0.81 to -0.47, <i>P</i> < 0.00001). The analgesic effects did not differ significantly among cooling modalities (<i>P</i> = 0.65). Cold therapy increased the odds of being ecchymosis-free at 48 h (OR = 2.77, 95% CI: 1.57-4.88, <i>P</i> = 0.0004) and reduced ecchymosis size at 48 h (SMD = -3.03, 95% CI: -4.95 to -1.10, <i>P</i> = 0.002). At 72 h, cold therapy increased the odds of being ecchymosis-free (OR = 4.17, 95% CI: 1.31-13.29, <i>P</i> = 0.02), but did not significantly reduce ecchymosis size (SMD = -0.76, 95% CI: -1.89 to 0.37, <i>P</i> = 0.19). Heterogeneity was substantial for ecchymosis size at 48 h (I2 = 98%); therefore, the magnitude of this pooled effect should be interpreted cautiously.<h4>Conclusion</h4>Local cold therapy may reduce immediate injection pain and early ecchymosis after subcutaneous heparin injection. Evidence at 72 h was outcome-dependent: ecchymosis-free status favored cold therapy, whereas ecchymosis size did not differ significantly. The findings should be interpreted cautiously because of high heterogeneity, outcome-specific risk of bias, and inconsistent reporting of intervention and measurement procedures.<h4>Systematic review registration</h4>https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278725, identifier CRD420261278725.

Abstract: PubMed · Datensatz