The effect of Buzzy application on pain and comfort level during heel stick in newborns: a randomized controlled study

Abstract

Aims: The aim of this study was to evaluate the effects of the Buzzy device application on pain levels and comfort in newborns during heel stick procedures. Methods: This randomized controlled experimental study was conducted at a Family Health Centre affiliated with the Public Health Directorate in a province in eastern Turkey between September and November 2024. The sample included 80 newborns born at 37–42 weeks of gestational age within the first 28 days of life (Buzzy group: n=40; control group: n=40). In the Buzzy group, the Buzzy device was applied approximately 30 seconds before the heel stick procedure. In the control group, the procedure was performed without any intervention. Data collection tools included the neonatal introduction form, the neonatal infant pain scale (NIPS), and the neonatal comfort behavior scale (NCBS). Ethical principles were adhered to throughout the study. Results: Pain levels and comfort scores during the heel stick procedure were significantly better in the Buzzy group compared to the control group (p<0.001). Analysis revealed that, in the control group, pain levels increased significantly, and comfort levels decreased markedly during the procedure. In contrast, the Buzzy group exhibited a more limited increase in pain levels and a less pronounced decrease in comfort. After the procedure, the pain scores were significantly lower, and comfort levels were higher in the Buzzy group compared to the control group (p<0.001). Conclusion: The Buzzy device was found to be an effective method for significantly reducing pain and maintaining comfort in newborns during heel stick procedures. These findings suggest that the Buzzy device can be a valuable tool for pain management and enhancing comfort in clinical settings. Future studies could explore the effectiveness of the device in larger populations and compare it with other pain management strategies.

Keywords

• Buzzy
• newborn
• pain
• comfort
• heel stick
• nursing

References

1. Apaydin Cirik V, Gül U, Kihtir Z, et al. The effect of using maternal voice, white noise, and holding combination interventions on the heel stick sampling. J Pediatr Nurs. 2023;70:1-11. doi:10.1016/j.pedn.2023.01.005
2. Peng HF, Yin T, Yang L, et al. Non-nutritive sucking, oral breast milk, and facilitated tucking relieve preterm infant pain during heel-stick procedures: a prospective, randomized controlled trial. Int J Nurs Stud. 2018;77:162-170. doi:10.1016/j.ijnurstu.2017.10.001
3. Karabıyık Oğurlu Ö, Tural Büyük E, Yildizlar O. The effect of warm compression applied before heel lance on pain level, comfort level and procedure time in healthy term newborns: a randomized clinical trial. J Midwifery Reproductive Health. 2020;8(3):2276-2283. doi:10.22038/jmrh.2020.41747.1475
4. Keels E, Sethna N, Watterberg KL, et al. Prevention and management of procedural pain in the neonate: an update. Pediatrics. 2016;137(2): e20154271. doi:10.1542/peds.2015-4271
5. Williams MD, Lascelles BDX. Early neonatal pain—a review of clinical and experimental implications on painful conditions later in life. Front Pediatr. 2020;8:30. doi:10.3389/fped.2020.00030
6. Aliefendioğlu D, Güzoğlu N. Yenidoğanda ağrı. Çocuk Sağlığı ve Hastalıkları Dergisi. 2015;58(1):35-42.
7. Özkan H, Mucuk Ö. Long-term effects of pain in children. Turkiye Klinikleri Pediatric Nursing-Special Topics. 2019;5(3):13-18.
8. Ranger M, Tremblay S, Chau CM, Holsti L, Grunau RE, Goldowitz D. Adverse behavioral changes in adult mice following neonatal repeated exposure to pain and sucrose. Front Psychol. 2019;9:2394. doi:10.3389/fpsyg.2018.02394

9. Brummelte S, Grunau RE, Chau V, et al. Procedural pain and brain development in premature newborns. Ann Neurol. 2012;71(3):385-396. doi:10.1002/ana.22267
10. Bucsea O, Riddell RP. Non-pharmacological pain management in the neonatal intensive care unit: managing neonatal pain without drugs. Semin Fetal Neonatal Med. 2019;24(4):101017. doi:10.1016/j.siny.2019.05. 009
11. Duerden EG, Grunau RE, Guo T, et al. Early procedural pain is associated with regionally-specific alterations in thalamic development in preterm neonates. J Neurosci. 2018;38(4):878-886. doi:10.1523/JNEUROSCI.0867-17.2017
12. Carbajal R, Rousset A, Danan C, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. Jama. 2008; 300(1):60-70. doi:10.1001/jama.300.1.60
13. Cruz MD, Fernandes A, Oliveira C. Epidemiology of painful procedures performed in neonates: a systematic review of observational studies. Eur J Pain. 2016;20(4):489-498. doi:10.1002/ejp.757
14. Shah VS. Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database Syst Rev. 2011;2011(10):CD001452. doi:10. 1002/14651858.CD001452.pub4
15. Carter BS, Brunkhorst J. Neonatal pain management. Semin Perinatol. 2017;41(2):111-116. doi:10.1053/j.semperi.2016.11.001
16. Yiğit Ş, Ecevit A, Köroğlu ÖA. Turkish Neonatal Society guideline on the neonatal pain and its management. Turk Pediatri Ars. 2018;53(Suppl 1):S161-S171. Published 2018 Dec 25. doi:10.5152/TurkPediatriArs.2018. 01802
17. Ünver F, Arslan FT. Pain in newborn. Pediatr Pract Res. 2019;7(Ek):97-102.
18. Ballard A, Khadra C, Adler S, Trottier ED, Le May S. Efficacy of the buzzy device for pain management during needle-related procedures: a systematic review and meta-analysis. Clinical J Pain. 2019;35(6):532-543. doi:10.1097/AJP.0000000000000690
19. Erdogan B, Ozdemir AA. The effect of three different methods on venipuncture pain and anxiety in children: distraction cards, virtual reality, and Buzzy®(randomized controlled trial). J Pediatr Nurs. 2021; 58:e54-e62. doi:10.1016/j.pedn.2021.01.001
20. Canbulat N, Ayhan F, Inal S. Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Manag Nurs. 2015;16(1):33-39. doi:10.1016/j.pmn.2014.03.003
21. Şahiner NC, İnal S, Akbay AS. The effect of combined stimulation of external cold and vibration during immunization on pain and anxiety levels in children. J Perianesth Nurs. 2015;30(3):228-235. doi:10.1016/j.jopan.2014.05.011
22. Moadad N, Kozman K, Shahine R, Ohanian S, Badr LK. Distraction using the BUZZY for children during an IV insertion. J Pediatr Nurs. 2016;31(1):64-72. doi:10.1016/j.pedn.2015.07.010
23. Baxter AL, Cohen LL, McElvery HL, Lawson ML, Von Baeyer CL. An integration of vibration and cold relieves venipuncture pain in a pediatric emergency department. Pediatr Emerg Care. 2011;27(12):1151-1156. doi:10.1097/PEC.0b013e318237ace4
24. Sivri Bilgen B, Balcı S. The effect on pain of Buzzy® and ShotBlocker® during the administration of intramuscular injections to children: a randomized controlled trial. J Korean Acad Nurs. 2019;49(4):486-494. doi:10.4040/jkan.2019.49.4.486
25. Redfern RE, Chen JT, Sibrel S. Effects of thermomechanical stimulation during vaccination on anxiety, pain, and satisfaction in pediatric patients: a randomized controlled trial. J Pediatr Nurs. 2018;38:1-7. doi: 10.1016/j.pedn.2017.09.009
26. Şıktaş Ö, Uysal G. The effect of buzzy application on pain level during vaccine injection in infants. J Nurs Care Qual. 2023;38(1):E9-E15. doi:10. 1097/NCQ.0000000000000656
27. McGinnis K, Murray E, Cherven B, McCracken C, Travers C. Effect of vibration on pain response to heel lance: a pilot randomized control trial. Adv Neonatal Care. 2016;16(6):439-448. doi:10.1097/ANC. 0000000000000315
28. Moayedi M, Davis KD. Theories of pain: from specificity to gate control. J Neurophysiol. 2013;109(1):5-12. doi:10.1152/jn.00457.2012
29. Butcher NJ, Monsour A, Mew EJ, et al. Guidelines for reporting outcomes in trial reports: the CONSORT-outcomes 2022 extension. Jama. 2022;328(22):2252-2264. doi:10.1001/jama.2022.21022
30. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993; 12(6):59-66.
31. Akdovan T. Assessment Of Pain in healthy neonates, investigation of the effects of pacifying and holding in the arms.İstanbul, Turkey: Health Science Institute, Marmara University. 1999.
32. Ambuel B, Hamlett KW, Marx CM, Blumer JL. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatr Psychol. 1992;17(1):95-109. doi:10.1093/jpepsy/17.1.95
33. Kahraman A, Başbakkal Z, Yalaz M. Turkish validity and reliability of comfortneo scale. Uluslararası Hakemli Hemşirelik Araştırmaları Dergisi. 2014;1(2):1-11.
34. Saghaei M. Random allocation software for parallel group randomized trials. BMC Med Res Methodol. 2004;4(1):1-6. doi:10.1186/1471-2288-4-26
35. Antepli NA, Kocamaz EB, Güngörmüş Z. The effect of vibration on pain during heel lance procedures in newborns: a randomized controlled trial. Adv Neonatal Care. 2022;22(2):E43-E47. doi:10.1097/ANC. 0000000000000918
36. Toennesen UL, Kierkegaard H, Kofoed PE, et al. Warming prior to heel stick: blood sample quality and infant comfort—a randomized controlled trial. Adv Neonatal Care. 2023;23(6):E129-E138. doi:10.1097/ANC.0000000000001110
37. Inal S, Aydin Yilmaz D, Erdim L. The effectiveness of swaddling and maternal holding applied during heel blood collection on pain level of healthy term newborns; randomized controlled trial. Early Child Development Care. 2021;192(13):2066-2077. doi:10.1080/03004430.2021. 1979536
38. Chang J, Filoteo L, Nasr AS. Comparing the analgesic effects of 4 nonpharmacologic interventions on term newborns undergoing heel lance: a randomized controlled trial. J Perinat Neonatal Nurs. 2020; 34(4):338-345. doi:10.1097/JPN.0000000000000495
39. Napiórkowska-Orkisz M, Gutysz-Wojnicka A, Tanajewska M, Sadowska-Krawczenko I. Evaluation of methods to minimize pain in newborns during capillary blood sampling for screening: a randomized clinical trial. Int J Environ Res Public Health. 2022;19(2):870. doi:10.3390/ijerph19020870
40. Sapkota PS, Bhandari SS, Karn BK, Yadhav U. Efficacy of heel warming on pain response to heel stick in neonates. J Nepal Paediatr Society. 2021; 41(1):48-53. doi:10.3126/jnps.v41i1.30786
41. Avcin E, Kucukoglu S. The effect of breastfeeding, kangaroo care, and facilitated tucking positioning in reducing the pain during heel stick in neonates. J Pediatr Nurs. 2021;61:410-416. doi:10.1016/j.pedn.2021.10. 002
42. Dur Ş, Çağlar S, Yıldız NU, Doğan P, Varal İG. The effect of Yakson and Gentle Human Touch methods on pain and physiological parameters in preterm infants during heel lancing. Intensive Crit Care Nurs. 2020;61: 102886. doi:10.1016/j.iccn.2020.102886
43. Yavaş S, Bülbül T, Topcu Gavas H. The effect on pain level and comfort of foot massages given by mothers to newborns before heel lancing: double-blind randomized controlled study. Jpn J Nurs Sci. 2021;18(4):e12421. doi:10.1111/jjns.12421
44. Deniz AÖ, Açikgöz A. A randomized controlled trial: the effect of acupressure and foot reflexology on pain during heel-lancing in neonates. Clin Nurs Res. 2023;32(2):306-312. doi:10.1177/105477382110618
45. Su HC, Hsieh CW, Lai NM, Chou PY, Lin PH, Chen KH. Using vibrating and cold device for pain relieves in children: a systematic review and meta-analysis of randomized controlled trials. J Pediatr Nurs. 2021;61: 23-33. doi:10.1016/j.pedn.2021.02.027
46. Bourdier S, Khelif N, Velasquez M, et al. Cold vibration (Buzzy) versus anesthetic patch (EMLA) for pain prevention during cannulation in children: a randomized trial. Pediatr Emerg Care. 2021;37(2):86-91. doi: 10.1097/PEC.0000000000001867
47. Potts DA, Davis KF, Elci OU, Fein JA. A vibrating cold device to reduce pain in the pediatric emergency department: a randomized clinical trial. Pediatr Emerg Care. 2019;35(6):419-425. doi:10.1097/PEC. 0000000000001041
48. Bergomi P, Scudeller L, Pintaldi S, Dal Molin A. Efficacy of non-pharmacological methods of pain management in children undergoing venipuncture in a pediatric outpatient clinic: a randomized controlled trial of audiovisual distraction and external cold and vibration. J Pediatr Nurs. 2018;42:e66-e72. doi:10.1016/j.pedn.2018.04.011
49. Lescop K, Joret I, Delbos P, et al. The effectiveness of the Buzzy-device to reduce or prevent pain in children undergoing needle-related procedures: the results from a prospective, open-label, randomised, non-inferiority study. Int J Nurs Stud. 2021;113:103803. doi:10.1016/j.ijnurstu.2020.103803
50. Benton S. Assessing the implementation of Buzzy® on pediatric units to decrease procedural pain. 2024.
51. Benjamin AL, Hendrix TJ, Woody JL. Effects of vibration therapy in pediatric immunizations. Pediatr Nurs. 2016;42(3):124.
52. Inal S, Kelleci M. The effect of external thermomechanical stimulation and distraction on reducing pain experienced by children during blood drawing. Pediatr Emerg Care. 2020;36(2):66-69. doi:10.1097/PEC. 0000000000001264
53. İnal S, Canbulat N. Using of distraction methods on procedural pain management of pediatric patients. J Health Sci Professions. 2015;2(3): 372-378. doi:10.17681/hsp.47420
54. Shoghi M, Dehghan A, Bozorgzad P. The effect of vibration on pain intensity during neonatal heel-blood sampling. Anaesthesia, Pain Intensive Care. 2023;27(2):191-197. doi:10.35975/apic.v27i2.2183
55. Hasanpour M, Tootoonchi M, Aein F, Yadegarfar G. The effects of two non-pharmacologic pain management methods for intramuscular injection pain in children. Acute Pain. 2006;8(1):7-12. doi:10.1016/j.acpain.2005.11.001
56. Malakian A, Dehdashtiyan M, Aramesh MR, Hassan SM, Aletayeb FG. Assessment of cooling effect on neonatal pain during heel prick blood sampling: a randomized clinical trial. Biomed Res. 2017;28(15):6880-6883.
57. Van Dijk M, Roofthooft DW, Anand KJ, et al. Taking up the challenge of measuring prolonged pain in (premature) neonates: the COMFORTneo scale seems promising. Clin J Pain. 2009;25(7):607-616. doi:10.1097/AJP. 0b013e3181a5b52a
58. Bektas İl, Oktay SŞ, Köylü P, Ulu H, Akdeniz Kudubeş A. The effect of breastfeeding on the newborn’s comfort and pain levels during heel blood collection. Compr Child Adolesc Nurs. 2024;47(1):20-30. doi:10. 1080/24694193.2023.2259991
59. Kahraman A, Gümüş M, Akar M, Sipahi M, Yılmaz HB, Başbakkal Z. The effects of auditory interventions on pain and comfort in premature newborns in the neonatal intensive care unit; a randomised controlled trial. Intensive Crit Care Nurs. 2020;61:102904. doi:10.1016/j.iccn.2020. 102904
60. Aydin D, İnal S. Effects of breastfeeding and heel warming on pain levels during heel stick in neonates. Int J Nurs Pract. 2019;25(3):e12734. doi:10. 1111/ijn.12734
61. Wang F, Zhang Q, Ni ZH, Lv HT. Effects of kangaroo care on pain relief in premature infants during painful procedures: a meta-analysis. J Spec Pediatr Nurs. 2022;27(4):e12390. doi:10.1111/jspn.12390