Effect of various interventions on relieving non-coring needle puncture-related pain in patients with totally implantable venous access port: a network meta-analysis of randomized control trials

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Background: The totally implantable venous access port (TIVAP) is an infusion device that can be permanently implanted in the subcutaneous tissue. However, patients with a TIVAP often experience considerable pain during non-invasive needle puncture. Alleviating this procedure-related pain is therefore particularly important. This network meta-analysis compared the effectiveness of several common interventions for reducing pain during non-invasive needle puncture in patients with a TIVAP, aiming to provide evidence to support clinical practice. Methods: Randomized controlled trials investigating pain reduction during non-invasive needle puncture in patients with a TIVAP were included. Two researchers independently screened the literature and extracted data. Study quality was assessed using the Cochrane Risk of Bias 2.0 (RoB2) tool. The quality of evidence was evaluated with the CINeMA (Confidence in Network Meta-Analysis) framework. Data analyses were performed using Stata 14 software. Results: Seven trials involving nine interventions and 942 patients were included. The network meta-analysis showed that, compared with placebo, cryotherapy, cutaneous stimulation therapy, and standard care, lidocaine cream combined with the Valsalva maneuver was associated with lower pain scores. Lidocaine spray, lidocaine cream, and the Valsalva maneuver alone also yielded lower pain scores compared with standard care. Lidocaine cream reduced pain scores compared with cutaneous stimulation therapy. Based on surface under the cumulative ranking curve (SUCRA) probabilities, the interventions ranked as follows: lidocaine cream combing with valsalva maneuver (93.3%) > lidocaine spray (79.6%) > lidocaine cream (68.6%) > valsalva maneuver (66.5%) > cold spray (51.3%) > placebo (33.3%) > cryotherapy (33.1%) > cutaneous stimulation therapy (18.2%) > standard care (6.1%). Conclusions: Based on the current evidence, lidocaine cream combined with the Valsalva maneuver had the highest probability of being the most effective among the evaluated interventions. However, the included randomized controlled trials were limited in number, the evidence network was sparse, the methodological quality of some studies was suboptimal, and direct head-to-head comparisons between different interventions were lacking. This finding should be regarded as an exploratory result derived from limited evidence and interpreted with caution. Therefore, strong clinical recommendations cannot be made at present. Larger, rigorously designed, and adequately blinded randomized controlled trials are needed to directly compare the most promising interventions (e.g., lidocaine cream combined with the Valsalva maneuver vs. lidocaine spray) and to employ standardized pain assessment tools together with clinically meaningful pain relief thresholds, in order to further validate these findings and guide clinical practice.

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