Network Meta-analysis Of Efficacy Of Local Analgesia Measures And Construction Of A Model On Adoption Intention In Pediatric Nurses

Objective:To compare and rank the efficacy of different local analgesia measures in reducing pain in children undergoing venipuncture and to explore the factors affecting the intention of pediatric nurses to adopt local analgesia measures in clinical application,aiming to providing evidence and basis for the clinical application of local analgesia measures in children undergoing venipuncture in the future.Methods:Network meta-analysis and a cross-sectional investigation.Nine local analgesia measures for the relief of venipuncture pain in children were searched through databases as follows:EMLA cream,4%lidocaine cream,lidocaine iontophoresis,amethocaine,needle-free lidocaine injection system,vapocoolant spray,EMLA patch,lidocaine/tetracaine heating patch and Buzzy.The studies included for analysis were randomized controlled trials(RCTs).The primary outcome was the self-reported pain by children.The software of STATA 14.0 was used for frequentist network Meta-analysis(NMA)and the confidence of the findings from the NMA was assessed using the CINe MA program.In addition,based on theory of innovation diffusion and theory of planned behavior,a model of adoption intention of pediatric nurses’clinical application of local analgesia measures was constructed,which included variables of relative advantage,ease of use,compatibility,subjective norms,perceived behavior control,adoption attitude and intention.AMOS 24.0 was used for structural equation model(SEM)analysis.Results:39 RCTs were included in the analysis.Results showed that vapocoolant spray was no more effective than placebo or routine care in reducing needle-associated pain in children.Other local analgesia measures produced greater pain reduction in children compared to placebo and routine care.Furthermore,amethocaine,Buzzy,lidocaine iontophoresis and EMLA cream were superior to vapocoolant spray in ease of pain.Buzzy was better than needle-free lidocaine injection system in pain relief.The remaining interventions between each other showed no difference.Amethocaine was the most effective local analgesia measure with the probability of being the best(56.9%),followed by Buzzy(20.5%)and lidocaine iontophoresis(8.1%).A total of 251 pediatric nurses were enrolled in the investigation.The results of SEM showed that the relative advantage and ease of use of local analgesia measures had a positive effect on pediatric nurses’attitude.However,the hypothesis of positive effect of compatibility on attitude wasn’t verified.The attitude,subjective norms and perceived behavior control of clinical application of local analgesia measures had a positive influence on the adoption intention of pediatric nurses.The fitness index of the model was as follows:χ~2/df=1.515,GFI=0.910,AGFI=0.880,RMSEA=0.045.The model could explain 71.4%of variance of pediatric nurses’adoption intention of local analgesia methods.Conclusion:Most local analgesia measures were effective in relieving pain in children undergoing venipuncture except vapocoolant spray which did not show greater pain reduction than placebo or routine care.Amethocaine was probably the top local analgesia measure to relieve pain in children undergoing venipuncture.In addition,the relative advantage and ease of use of local analgesia measures could indirectly influence the adoption intention through attitude.Attitude,subjective norms and perceived behavior control of local analgesia measures had a positive impact on pediatric nurses’intention to adopt.Among them,the attitude contributed to the strongest effect on the adoption intention.The model could strongly explain the willingness of pediatric nurses to use local analgesia measures.