Objective:

To compare the effectiveness of several common interventions for reducing pain during non-invasive needle puncture in patients with a TIVAP.

Approach:

• Study Inclusion: Randomized controlled trials investigating pain reduction during non-invasive needle puncture in patients with a TIVAP were included.
• Data Extraction: Two researchers independently screened the literature and extracted data.
• Quality Assessment: Study quality was assessed using the Cochrane Risk of Bias 2.0 (RoB2) tool and the quality of evidence was evaluated with the CINeMA framework.
• Data Analysis: Data analyses were performed using Stata 14 software.

Key Findings:

• Lidocaine cream combined with the Valsalva maneuver was associated with lower pain scores compared to placebo, cryotherapy, cutaneous stimulation therapy, and standard care.
• Lidocaine spray, lidocaine cream, and the Valsalva maneuver alone also yielded lower pain scores compared to standard care.
• Lidocaine cream reduced pain scores compared to cutaneous stimulation therapy.
• Interventions ranked by effectiveness: lidocaine cream combined 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%).

Interpretation:

Lidocaine cream combined with the Valsalva maneuver had the highest probability of being the most effective intervention among those evaluated.

Limitations:

• Limited number of randomized controlled trials included.
• Sparse evidence network.
• Suboptimal methodological quality of some studies.
• Lack of direct head-to-head comparisons between different interventions.

Conclusion:

Findings should be regarded as exploratory and interpreted with caution; larger, rigorously designed trials are needed to validate these results.