Article Text

FRI0449 Evaluationg the effect of valsalva maneuver on pain occurring during knee injection: A prospective, randomized study
  1. A. Abogamal
  1. Rheumatology, Alazhar Faculty of Medicine, Cairo, Egypt


Background Intra-articular injection of steroid is a common treatment for osteoarthritis of the knee and injection is a simple and reliable method However many people refuse it because of fear of needle and injection pain. baroreceptor activation induces antinociception and the use of Valsalva maneuver for its activation may decrease local injection pain.

Objectives This study was the first to evaluate the efficacy of Valsalva maneuver on needle insertion pain during local knee injection.

Methods Patients were randomized into 2 groups of 50 each. Group I: 50 patients with Knee Osteoarthritis were asked to do valsalva maneuver during injection. The Valsalva maneuver is performed by having the subject conduct a maximal, forced expiration against a closed glottis and holding this for at least 16 seconds. Group II: 50 patients with Knee Osteoarthritis were given a rubber ball in the palm of the hand and were asked to press it as hard as they could before local injection. All patients were subjected to: Complete history and clinical examination. Patient Pain scoring: pain during injection was evaluated using visual analogue scale (VAS) Physician pain scoring.

Results The results of Pain score in goup I was: 33 (66%) patients shows mild pain, 15 (30%) patients shows moderate pain and only 2 (4%) patients shows sever pain. In group II: 0% patients shows mild pain, 23 (46%) patients shows moderate pain and 27 (54%) patients shows sever pain. Figure (1) VAS for pain was 3.7+2.1 in group I and 6.5+1.8 in group II. VAS for pain was significantly lower in group I than group II as p was >0.001.

Conclusions In conclusion we suggest that Valsalva maneuver can decrease the skin puncture pain associated with local knee injection which may help the patients to decrease their pain and increase their acceptance to local injection.

Disclosure of Interest None Declared

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