Natasha Broemling

Understanding parental experience of the Magic Glove as a technique to reduce pain and anxiety during preoperative IV insertion: A Qualitative Study

Total intravenous anesthesia (TIVA) is general anesthesia given only through intravenous agents which reduces post-operative emergence delirium, respiratory complications, nausea and vomiting, as well as easier maintenance of spontaneous ventilation compared with inhalational anaesthesia. One disadvantage of TIVA is that it requires preoperative intravenous (IV) access, which uses a needle for insertion of an IV cannula while the patient is awake. Preoperative pain and anxiety are often focused on the insertion of this needle. IV needle insertion and other needle-related procedures are common causes of pain and distress in children presenting for surgery and may lead to the development of needle aversion and avoidance of medical procedures into adulthood. Preoperative pain and anxiety predict poor postoperative outcomes, including emergence delirium, increased pain and analgesic requirements, longer recovery times, ongoing sleeping and eating problems, bed wetting, and reduced capacity to cope with future medical procedures. Minimizing pain and anxiety associated with IV insertion is a clinical priority.

BCCH standard practice for IV anesthesia induction includes applying a topical anesthetic cream, parents accompanying their child to the operating room, providing the BCCH parental ‘hug,’ and auditory or visual distraction techniques. None of these techniques completely alleviate a child’s distress because the perceived bother about the procedure is distinct from the analgesia conferred by topical agents. Hypnosis, an altered state of consciousness unique from ordinary consciousness and sleep, involves a deliberate narrowing of attention and suspension of critical judgement, and has been demonstrated to have effects on physiological processes. Reductions in perioperative pain and anxiety may be achieved with a hypno-analgesic technique called the Magic Glove. Used since the 1970s in pediatric practice, the Magic Glove uses touch with hypnotic suggestion to create a comfort sensation in a child’s hand and reduce anxiety so that the child feels less bothered by an IV insertion. Dr. Leora Kuttner developed a protocol for the hypno-analgesic technique to provide a sense of protection, greater control, and less pain and anxiety before and during the invasive procedure.

This study aims to explore the feasibility and acceptability of applying the Magic Glove technique preoperatively in the BCCH Anesthetic Care Unit (ACU) for easing patient and caregivers’ stress, anxiety, and perceived pain upon IV Cannulation. Additionally, we hope to hear from a caregiver’s perspective about how we can further develop the Magic Glove technique to make the process more pleasant or accessible for future families.

Grants

Co-Investigator. Understanding parental experience of the Magic Glove as a technique to reduce pain and anxiety during preoperative IV insertion: A Qualitative Study. Funding Source: E2I Research Theme Seed Grant