Reduced Pain of Intraarticular Hyaluronate Injection With the Reciprocating Procedure Device

Abstract

Patients have considerably more pain with intraarticular needle introduction and injectable hyaluronate therapy than physicians estimate. The RPD reduces patient pain, reduces procedure time, and improves needle introduction compared with the conventional syringe for hyaluronate injection therapy for the knee.

A Randomized, Controlled Trial of the Reciprocating Procedure Device for Local Anesthesia

“…The improvement in physician performance in terms of procedure duration and reduced patient pain with the RPD could not be attributed to practice effects, as the physicians had far more practice with the conventional syringe (1533 Ϯ 812.43 local anesthesia procedures) than the RPD (24.6 Ϯ 18.7 local anesthesia procedures, p Ͻ 0.001). These results suggest that improved physician performance with the RPD in local anesthesia was related to the better intrinsic mechanical control characteristics of the RPD, as has been previously demonstrated (21)(22)(23)(24)(25).…”

“…Previous efforts at reducing pain during the administration of local anesthesia have concentrated on proper syringe and needle technique, buffering the local anesthetic agent, and alternative methods to the traditional syringe and needle (8 -19). Because design inadequacies of the traditional syringe promote poor control of the needle during typical syringe procedures, we hypothesized that inadequate control of the syringe and needle also might be contributing significantly to anesthesia administration pain (21)(22)(23)(24)(25).…”

“…Unlike a conventional syringe or the three-ring control syringe, the RPD does not become longer during the aspiration phase, which further enhances control of the needle (20,21). These characteristics of stable finger positioning, the exclusive use of the flexor musculature, and the absence of device lengthening during aspiration create a powerful and finely controlled one-handed procedure device (21)(22)(23)(24)(25). Recently, clinical trials have demonstrated that the RPD is less painful and is superior to the traditional syringe for arthrocentesis, corticosteroid joint injections, suction needle biopsy, intra-articular hyaluronate injections, and other syringe and needle aspiration procedures performed by physicians (21)(22)(23)(24)(25).…”

“…These characteristics of stable finger positioning, the exclusive use of the flexor musculature, and the absence of device lengthening during aspiration create a powerful and finely controlled one-handed procedure device (21)(22)(23)(24)(25). Recently, clinical trials have demonstrated that the RPD is less painful and is superior to the traditional syringe for arthrocentesis, corticosteroid joint injections, suction needle biopsy, intra-articular hyaluronate injections, and other syringe and needle aspiration procedures performed by physicians (21)(22)(23)(24)(25). A one-handed syringe device with enhanced control characteristics where the free hand can be used for device stabilization, anatomic localization, wound exposure, patient restraint, and other necessary tasks is an obvious advantage for emergency procedures, including anesthesia.…”

Procedure-Oriented Sectional Anatomy of the Knee

“…Complications related to injections in the knee include intraneural injection, 24 inaccurate needle placement, 25 pain, 26,27 osteonecrosis, 28 patellar tendon rupture, 29 septic arthritis, 30 systemic tuberculosis, 31 hyperglycemia in noninsulin-dependent diabetes, 32 subcutaneous atrophy, 33 hematomas, 34 and wound exudation with articular subsidence after injection of calcium for tibial plateau fractures. 15 Sala Branch et al 24 found that intraneural injection occurred in 66% (28/42) of nerve stimulator-guided sciatic nerve blocks in the popliteal fossa (Figs.…”