Education or sedation? A randomized clinical trial of impact on procedural pain and satisfaction during regional block placement, and the moderating effect of pain catastrophizing.
rct · Level II
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- Record sourced from PubMed, PMID 40473409.
- Also identified by DOI 10.1136/rapm-2025-106644 and PMC identifier 13084057.
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Abstract
Preoperative peripheral nerve block placement can involve both procedural pain and psychological distress, which practitioners treat using both sedation and education/reassurance. The experience of pain may be potently modulated by baseline pain catastrophizing (presence of rumination, magnification, and helplessness). This randomized clinical trial assessed whether the treatment effect of sedation vs education/reassurance on procedural nerve block pain and satisfaction varied for patients with different baseline pain catastrophizing scores. At baseline, patients completed the Pain Catastrophizing Scale (PCS), were stratified into low-PCS (<10) or high-PCS (≥10) groups, and then randomized to receive sedation or education/reassurance during nerve block placement. Patients reported maximum and average procedural pain and satisfaction, immediately after the procedure and recalled in the postanesthesia care unit (PACU). Generalized estimating equations examined main effects of treatment and baseline PCS group on maximum procedural pain and the interaction between them. Maximal procedural pain immediately after the procedure was similar between treatment groups (n=72), but a significant treatment×PCS group interaction (B=0.8, 95% CI (0.04, 1.5), p=0.04) indicated that among patients with high PCS, sedation was associated with less pain (2.3±2.2 vs 4.3±2.5, p=0.01). Exploratory findings indicate sedation being associated with lower recalled procedural pain in PACU than education/reassurance (0.3±0.7 vs 2.2±2.4, p<0.001), and education being associated with higher satisfaction among those with lower PCS. Our findings suggest that patients with high PCS may disproportionately benefit from sedation during nerve block, reporting less pain, whereas patients with low PCS may have a slight preference for education/reassurance, reporting higher satisfaction. NCT05579509.