Email this article The impact of vagal nerve stimulation from the lateral neck region on venous cannulation pain: A randomized controlled trial
DOI: https://doi.org/10.20528/cjpm.2025.02.003
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Background: As the cranial nerve with the longest and widest distribution area of the body, the vagus nerve (N.Vagus) has both antinociceptive and neuromodulatory effects and plays a role in the regulation of the heart rate. The objective of this study is to investigate the impact of cold stimulation on vascular access discomfort and heart rate variability, specifically by separately stimulating the N. Vagus nerve on both the right and left sides of the neck thereby assessing any lateralization effect.
Methods: 140 patients, ranging in age from 18 to 75, were randomly assigned to one of two groups: Group Left (Group L) or Group Right (Group R). Following cold application to the left lateral neck region of Group L and the right lateral neck region of Group R, venous cannulation was performed. Prior to, following, and subsequent to vascular access, the heart rate, noninvasive blood pressure, oxygen saturation, and numeric pain scale (NRS) values for venous cannulation pain of the patients were documented.
Results: Average heart rates and average heart rates after cannulation were considerably lower in both groups after vagal stimulation (p<0.05). No significant difference was observed when comparing the average heart rate values for each time period in Group L and Group R, including the mean heart rate values before vagal stimulation, after vagal stimulation, and after vascular access (p>0.05). The mean heart rate change percentages before and after vagal stimulation were 7±5.8% and 7.1±7.0% in group L and group R respectively, suggesting that heart rate variability was greater in Group R, although this difference was not statistically significant (p>0.05). NRS values were found to be 2.64±1.28 in Group L and 2.85±1.62 in Group R, with no significant difference (p>0.05).
Conclusion: While heart rate variability exhibited more prominence on the right side, the difference was not statistically significant. Analyzing the analgesic impact revealed no discernible difference between the analgesic effects of stimulation from the right and left sides.
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This article has an Erratum. Please see: https://doi.org/10.20528/cjpm.2025.03.007
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References
Butt MF, Albusoda A, Farmer AD, Aziz Q. The anatomical basis for transcutaneous auricular vagus nerve stimulation. J Anat. 2020;236(4):588–611.
Shao P, Li H, Jiang J, Guan Y, Chen X, Wang Y. Role of vagus nerve stimulation in the treatment of chronic pain. Neuroimmunomodulation. 2023;30(1):167–183.
Neves ML, Karvat J, Simões RR, Speretta GFF, Lataro RM, da Silva MD, Santos ARS. The antinociceptive effect of manual acupuncture in the auricular branch of the vagus nerve in visceral and somatic acute pain models and its laterality dependence. Life Sci. 2022;309:121000.
Ren K, Zhuo M, Randich A, Gebhart G. Vagal afferent stimulation-produced effects on nociception in capsaicin-treated rats. J Neurophysiol. 1993;69(5):1530–1540.
Szulczewski MT. Transcutaneous auricular vagus nerve stimulation combined with slow breathing: Speculations on potential applications and technical considerations. Neuromodulation. 2022;25(3):380–394.
Howland RH. Vagus nerve stimulation. Curr Behav Neurosci Rep. 2014;1:64–73.
Yap JY, Keatch C, Lambert E, Woods W, Stoddart PR, Kameneva T. Critical review of transcutaneous vagus nerve stimulation: Challenges for translation to clinical practice. Front Neurosci. 2020;14:284.
Asher GN, Jonas DE, Coeytaux RR, Reilly AC, Loh YL, Motsinger-Reif AA, Winham SJ. Auriculotherapy for pain management: A systematic review and meta-analysis of randomized controlled trials. J Altern Complement Med. 2010;16(10):1097–1108.
Hilz MJ. Transcutaneous vagus nerve stimulation: A brief introduction and overview. Auton Neurosci. 2022;103038.
Simon B, Blake J. Mechanism of action of non-invasive cervical vagus nerve stimulation for the treatment of primary headaches. Am J Manag Care. 2017;23(17 Suppl):S312–S316.
Kumar S, Gautam SKS, Gupta D, Agarwal A, Dhirraj S, Khuba S. The effect of Valsalva maneuver in attenuating skin puncture pain during spinal anesthesia: A randomized controlled trial. Korean J Anesthesiol. 2016;69(1):27–31.
Jungmann M, Vencatachellum S, Van Ryckeghem D, Vögele C. Effects of cold stimulation on cardiac-vagal activation in healthy participants: Randomized controlled trial. JMIR Form Res. 2018;2(2):e10257.
Agarwal A, Sinha PK, Tandon M, Dhiraaj S, Singh U. Evaluating the efficacy of the Valsalva maneuver on venous cannulation pain: A prospective, randomized study. Anesth Analg. 2005;101(4):1230–1232.
Kirchner A, Birklein F, Stefan H, Handwerker H. Left vagus nerve stimulation suppresses experimentally induced pain. Neurology. 2000;55(8):1167–1171.
Öztürk E, Erdil FA, Begeç Z, Yücel A, Şanlı M, Ersoy MÖ. İntravenöz kanülasyon ağrısına buzun etkisi. Fırat Tıp Derg. 2009;14(2):108–110.
Gupta D, Agarwal A, Dhiraaj S, Tandon M, Kumar M, Singh RS, Singh PK, Singh U. An evaluation of efficacy of balloon inflation on venous cannulation pain in children: A prospective, randomized, controlled study. Anesth Analg. 2006;102(5):1372–1375.
Canikli Adıgüzel S, Akyurt D, Ültan Özgen G, Bahadır Altun H, Çakır A, Süren M, Okan İ. The effect of cold application to the lateral neck area on peripheral vascular access pain: A randomised controlled study. J Clin Med. 2023;12(19):6273.
Premchand RK, Sharma K, Mittal S, Monteiro R, Dixit S, Libbus I, DiCarlo LA, Ardell JL, Rector TS, Amurthur B. Autonomic regulation therapy via left or right cervical vagus nerve stimulation in patients with chronic heart failure: Results of the ANTHEM-HF trial. J Card Fail. 2014;20(11):808–816.
Machetanz K, Berelidze L, Guggenberger R, Gharabaghi A. Transcutaneous auricular vagus nerve stimulation and heart rate variability: Analysis of parameters and targets. Auton Neurosci. 2021;236:102894.
Chen PS, Chen LS, Fishbein MC, Lin SF, Nattel S. Role of the autonomic nervous system in atrial fibrillation: Pathophysiology and therapy. Circ Res. 2014;114(9):1500–1515.
Buschman HP, Storm CJ, Duncker DJ, Verdouw PD, van der Aa HE, van der Kemp P. Heart rate control via vagus nerve stimulation. Neuromodulation. 2006;9(3):214–220.
Koltzenburg M, Handwerker HO. Differential ability of human cutaneous nociceptors to signal mechanical pain and to produce vasodilatation. J Neurosci. 1994;14(3):1756–1765.
Bantel C, Trapp S. The role of the autonomic nervous system in acute surgical pain processing: What do we know? Anaesthesia. 2011;66(7):541–544.
Likar R, Perruchoud C, Kampusch S, Köstenberger M, Sator S, Stremnitzer C, Wolf A, Neuwersch-Sommeregger S. Klinische Wirksamkeit der aurikulären Vagusnervstimulation in der Behandlung chronischer und akuter Schmerzen. Schmerz. 2023;1–12.
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