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Warming diptheria-tetanus vaccines doesn't reduce pain

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7414.0-f (Published 04 September 2003) Cite this as: BMJ 2003;327:0-f

Question Does warming diphtheria-tetanus vaccine reduce the discomfort of the injection?

Synopsis Many healthcare providers warm the phials containing diphtheria-tetanus vaccine before injection to reduce pain and side effects. A convenience sample of 150 patients aged 16 years or older cared for in an emergency department who required a diphtheria-tetanus booster vaccination was identified. Subjects were randomly assigned in a double blind fashion (concealed allocation assignment) to receive a vaccine that had been given no deliberate warming (“cold”); rubbed for one minute between a nurse's hands (“rubbed”); or placed in a 37°C warming cupboard for five minutes (“warmed”). The temperature of the liquid in the syringe was measured with a flux wire temperature probe immediately before injection. All outcomes were assessed five minutes after injection and at 24 and 48 hours by individuals blind to treatment group assignment. A total of 92% of the patients were available for complete follow up. With intention to treat analysis, no significant differences between the vaccine groups in the incidence of pain or the number of adverse reactions after injection were noted at any of the follow up evaluations. Interestingly, the temperature of the vaccines immediately before injection approached ambient temperature in all three groups, most likely secondary to the large surface area of the syringe relative to the small amount of fluid (0.5 ml). I would have liked the authors to have evaluated the pain immediately after injection to see if there was any difference between the groups.

Bottom line Warming the adult diphtheria-tetanus vaccine either by rubbing in the hands or with a warmer does not reduce the incidence of pain or adverse reactions after injection. Although the study was done only on adults, there is no reason to assume that warming is beneficial for children.

Level of evidence 1b (see www.infopoems.com/resources/levels.html); individual randomised controlled trials (with narrow confidence interval).

Maiden MJ, Benton GN, Bourne RA. Effect of warming adult diphtheria-tetanus vaccine on discomfort after injection: a randomised controlled trial.Med J Aust 2003 ;178: 433-6.

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