Characterization and management of pain across phases of intraosseous infusion in emergency department patients with non-cardiac arrest.

OBJECTIVES

To identify risk factors for moderate-to-severe pain during intraosseous infusion (IOI) in non-cardiac arrest patients in the emergency department (ED). Secondary aims include evaluating pain trajectory across procedural stages and assessing the efficacy of a personalized pain management strategy.

METHODS

This mixed-methods study analyzed 220 ED patients undergoing IOI (150 retrospective, 70 prospective). The prospective cohort was randomized to standard care (n=35) or personalized pain management (n=35). Pain was quantified using the numeric rating scale (NRS) and critical-care pain observation tool (CPOT).

RESULTS

During puncture, 35.33% (53/150) reported no/mild pain. Pain severity peaked during flushing, with 73.33% (110/150) experiencing moderate/severe pain. At 15-minute infusion, this decreased to 57.33% (86). Univariate analysis identified gender and BMI as pain-associated factors (p<0.05). Multivariate analysis confirmed female gender (OR=13.468) and low BMI (OR=7.250) as independent risk factors (p<0.05). Compared to the control group, the personalized strategy group demonstrated significantly lower pain scores during puncture, flushing, and early infusion, with reduced analgesic requirements in the first 2 stages. No between-group differences occurred in puncture success or complication rates.

CONCLUSION

Intraosseous infusion flushing induces the most severe pain, particularly among females and low-BMI patients. Personalized, stage-targeted analgesia significantly improves pain control without compromising safety, supporting its integration into emergency IOI protocols.