Exploring the effectiveness of virtual technology combined with lidocaine cream in pediatric puncture pain management

1. Introduction

Puncture procedures are among the most common clinical operations and are essential for treating numerous diseases. However, pediatric patients often experience significant physical pain and discomfort during punctures due to their young age, and this can lead to crying, resistance or refusal of treatment, thereby affecting the progress of the procedure and subsequent treatments. Such adverse reactions not only impact the child’s physical state but also disrupt the overall course of therapy and condition management [1]. Therefore, effective pain management during puncture procedures is essential [2] because inadequate pain management can have long-term consequences, including avoidance behaviors and oppositional attitudes towards medical procedures. These behaviors can hinder the progression of nursing interventions, increase the difficulty of nursing and communication, damage the nurse-patient relationship, slow down recovery and negatively affect the child’s quality of life and well-being during hospitalization [3]. Thus, identifying appropriate pain management strategies is particularly imperative for hospitalized children.

Conventional procedural pain interventions include pharmacological and non-pharmacological measures, such as topical anesthetics, non-nutritive sucking, glucose administration and play therapy [4]. Only reliance on pharmacological treatment may be insufficient to alleviate all discomfort, while non-pharmacological interventions might not effectively relieve pain, leading to emotional instability and psychological disturbances, thereby impacting subsequent treatments.

Virtual reality (VR) technology employs various technical means, including computer systems that generate three-dimensional real-time animations and head-mounted displays equipped with motion trackers and data processors [5]. Currently, VR is primarily used for mental health interventions, remote live surgical broadcasts, debridement and rehabilitation for burn patients, organ transplant pain management, cancer patient injections, dental pain interventions and other scenarios [6]. In recent years, VR technology has been widely applied in disease treatment and interventions, achieving favorable outcomes.

Therefore, this study investigates the effect of VR technology combined with lidocaine cream on operant pain intervention in hospitalized children of different ages.

2. Materials and methods

2.1 General information

This study included 150 hospitalized children who voluntarily participated in pain management at our hospital between February 2023 and February 2024 (Fig. 1). The participants were divided into three groups, each containing 50 children, based on the intervention method they underwent: experimental group 1, experimental group 2 and a control group. The baseline characteristics of the patients were comparable across all groups (p > 0.05) (Table 1).

Fig. 1.Flow chart of the study design and grouping.

Table 1.Comparison of general information among the three groups.

Group	n	Gender (Male/Female)	Age (yr)	Puncture frequency
Control group	50	25/25	6.70 ± 2.49	1.24 ± 0.43
Experimental group 1	50	26/24	6.68 ± 2.70	1.20 ± 0.40
Experimental group 2	50	23/27	6.55 ± 2.58	1.20 ± 0.38
χ2/F	-	0.373	0.049	0.164
p	-	0.830	0.952	0.849
Group	n	Heart rate (beats/min)	Breathing (times/min)	Oxygen saturation (%)
Control group	50	105.34 ± 8.04	27.24 ± 3.04	98.35 ± 0.47
Experimental group 1	50	104.20 ± 8.48	27.16 ± 3.31	98.42 ± 0.51
Experimental group 2	50	106.16 ± 7.89	26.64 ± 3.46	98.55 ± 0.55
F	-	0.731	0.495	1.972
p	-	0.483	0.611	0.143

Inclusion criteria for the study were as follows: children aged 3–7 years, a pain score of 0 before cannulation, intended for puncturing without scars, allergies or venous thrombosis in the limb [7], and informed consent obtained from both the child and parents, with a signed consent form. Exclusion criteria included children unable to wear virtual reality glasses, children with abnormal coagulation functions [8] and children allergic to lidocaine.

3. Results

4. Discussion

Procedural pain refers to short-term discomfort typically caused by invasive operations or diagnostic procedures, such as venipuncture, bone marrow aspiration, lumbar puncture and the insertion of chemotherapy pumps. Children who experience repeated procedural pain may suffer both immediate and long-term adverse effects, including post-traumatic stress disorder, sleep disturbances, physiological responses, depression, hormonal imbalances, cognitive-behavioral changes and other psychological sequelae [12]. In extreme cases, this can lead to neurogenic shock or suicidal ideation. Therefore, appropriate pain intervention is critically important for hospitalized children. Despite extensive research on pediatric procedural pain, effective interventions remain scarce in clinical practice. Pain comprises sensory, emotional and cognitive dimensions, making pharmacological treatment alone insufficient to alleviate all discomfort. Thus, it is essential to adopt scientifically validated intervention measures to reduce pain during procedures.

Modern medicine considers pain to be a complex phenomenon characterized as an unpleasant subjective sensation associated with actual or potential tissue damage, and involving sensory, emotional and cognitive processes [13]. Current approaches to pain relief primarily involve methods such as acupoint massage and analgesic drugs, which have shown significant efficacy. As a psychological intervention, VR technology can effectively distract attention and alleviate pain during invasive procedures due to its high safety and efficiency [14]. It has been reported that VR technology, a potent non-pharmacological analgesic approach in clinical practice, can significantly reduce pain and discomfort in children and plays an important role in pediatric pain management. Compared to pharmacological treatments, VR offers advantages such as low risk, ease of use, no pain and no adverse reactions, and it can significantly lower children’s objective pain scores [15].

Additionally, lidocaine cream has been widely used for pain relief before various invasive procedures and is considered suitable for children [16]. The results of our present study indicated that during and after the puncture, the pain scores in experimental group 2 were lower than those in the control group and experimental group 1, suggesting that the combination of compound lidocaine cream and VR technology can effectively reduce patients’ pain during treatment. Compound lidocaine cream, commonly used for pain control during pediatric venipuncture in clinical practice, provides effective surface anesthesia by topical application, blocking superficial sensory nerves and preventing the formation of pain reflexes, thereby achieving pain relief. VR technology reduces pain sensitivity through the activation of higher cognitive functions such as focus, attention, and memory, enhancing the patient’s engagement with pleasant stimuli and having significantly fewer side effects compared to pharmacological analgesia. Furthermore, the use of virtual videos as an intervention has proven to be more effective than mobile videos [17].

Furthermore, compared to playing videos on cell phones, VR headsets provide an immersive experience through visual, auditory, and tactile sensations that shield the child’s eyes from directly witnessing the puncture process, which can potentially intensify emotions such as tension. This effectively distracts the patient’s attention away from pain, thereby enhancing the analgesic effect [18]. The combination of lidocaine cream and VR can have a synergistic effect, strengthening pain relief. Additionally, this combination has been highly recognized by both parents and children for its engaging interactive approach and efficient intervention method, creating an excellent medical experience. Therefore, the combined intervention is more effective than using lidocaine cream or VR technology alone.

After puncturing, the medical fear scores for both individual dimensions and the total score for experimental group 2 were lower than those of the control group and experimental group 1. This indicates that the combination of lidocaine cream and VR can effectively reduce children’s medical fear. When children experience reduced pain after applying compound lidocaine cream, their fear and resistance toward pain also decrease, thereby improving cooperation during the procedure. However, since pain during the procedure is influenced by multiple factors, medication alone is not sufficient. For children who do not cooperate or exhibit negative emotions, games can be used to relieve psychological pressure, lessen fear and increase cooperation. In VR therapy, children can choose videos they like to watch, with puncture-related knowledge subtly integrated through simple introductions and encouragement for the child to try. As children become immersed, their sense of self-satisfaction, self-awareness, self-evaluation, and self-regulation abilities continuously increase, thus reducing anxiety, eliminating fear of puncture, and improving compliance. VR interventions also bridge the distance between the child and the doctor, fostering trust and fondness towards the doctor, ensuring the smooth progress of the procedure, and improving the medical experience for the child and their family [19].

VR can be used to transform the treatment environment for children by incorporating themes of fun and playfulness to capture their attention and alleviate the psychological fear associated with medical procedures, thereby improving their mental state. Satisfaction scores, as well as knowledge and attitudes about pain, are significantly higher in experimental group 2 compared to the control group and experimental group 1. This demonstrates that combining VR with lidocaine cream significantly enhances parental satisfaction with the entire procedural process. The immersive experience created by VR reduces physical pain and, through human-computer interaction, increases children’s interest and engagement. Although VR does not block pain signals, it mitigates pain perception through advanced central processes such as attention, emotion and memory. Since pain perception requires attention, diverting the patient’s attention to VR slows their response to pain signals, thereby reducing both pain perception and medical fear. This approach promotes a more positive attitude toward puncture treatments, thereby increasing parental satisfaction. Children’s curiosity is effectively engaged by VR technology, which helps them ignore external pain and cooperate more actively with nurses during procedures. Therefore, parents report higher satisfaction with nursing interventions due to their children’s cooperation and enthusiasm. Throughout the treatment process, healthcare professionals also educate and train parents about pain-related knowledge. As a result, parents in experimental group 2 demonstrate a high level of understanding and mastery of pain management knowledge and attitudes.

The Crying and puncture times in experimental groups 1 and 2 are lower than in the control group, with group 2 having shorter times than group 1. The first-attempt success rate for venipuncture was found to be higher in group 2 than in group 1 and the control group. Compound lidocaine cream, a low-solubility oil-water mixture, can penetrate quickly and completely into the patient’s skin. It offers advantages such as good adhesiveness and penetration, rapid onset, mild local irritation and high utilization. Only a small amount of the drug needs to be applied locally, resulting in minimal systemic effects on the child. The immersive and interactive nature of VR is more effective than music therapy because attention to engaging stimuli can alleviate anxiety and improve emotional states due to the limited capacity of personal attention [20]. The combination of lidocaine and VR significantly reduces children’s pain perception, lowers their pain scores and decreases the time nurses spend preparing for and conducting punctures. Therefore, children’s crying time is greatly reduced, and the puncture process proceeds smoothly. The number of punctures required is fewer, and the success rate on the first attempt is higher than for children who used only VR or lidocaine cream alone.

Dalir et al. [21] reported that virtual reality technology captures patients attention by immersing them in a simulated computer world. Given the brain’s limitations in processing information, this technology engages multiple sensory inputs simultaneously, which in turn reduces the patient’s focus on pain signals and alleviates pain sensation [21]. Moreover, Almajed et al. [22] conducted an experiment evaluating the effectiveness of virtual reality technology in managing pain and anxiety levels in 4–6 years old children during dental surgery. He found that game-based VR systems were the most effective and yielded the most positive results in children’s medical interventions. This effectiveness is attributed to the children’s full participation and interaction with the games, making VR particularly valuable for mitigating pain and anxiety [22].

In addition, the combination of lidocaine and VR has broadened its application, extending its use across all pediatric systems in the hospital and even into obstetrics and gynecology departments. The use of lidocaine and VR does not increase the risk of allergies or affect vision in children, ensuring good safety. However, the relatively small sample size in this study may introduce bias in the results. Future research should increase the sample size and conduct multicenter studies to enhance the accuracy and generalizability of the findings.

5. Conclusions

In summary, the combination of virtual reality technology and lidocaine cream in managing pediatric puncture pain effectively reduces pain, decreases medical fear, improves nursing satisfaction, enhances parental mastery of pain knowledge and attitudes, reduces crying and increases the success rate of first-attempt venipuncture. This approach is worthy of clinical promotion.

Availability of data and materials

The authors declare that all data supporting the findings of this study are available within the paper and any raw data can be obtained from the corresponding author upon request.

Author contributions

JMW and XFX—designed the study and carried them out; prepared the manuscript for publication and reviewed the draft of the manuscript. JMW, XFX, HW, XLS, SYC, HHS, LLW and XFZ—supervised the data collection. JMW, XFX, HW, XLS, SYC and HHS—analyzed the data. JMW, XFX, HW and XLS—interpreted the data. All authors have read and approved the manuscript.

Ethics approval and consent to participate

Ethical approval was obtained from the Ethics Committee of Hangzhou Linping District Maternal & Child Health Care Hospital (Approval no. LLSC-KYKT-2022-0090-A). Informed consent was obtained from both the child and parents, with a signed consent form.

Acknowledgment

Not applicable.

Funding

This work was supported by Medical and Health Technology Project in Hangzhou, Zhejiang (Grant No. B20231926) and Zhejiang Provincial Medical and Health Technology Plan (Grant No. 2022KY853).

Conflict of interest

The authors declare no conflict of interest.