Needle phobia is a significant concern in the perioperative setting, affecting both pediatric and adult patients. The condition can lead to extreme anxiety, vasovagal reactions, and even refusal of necessary medical procedures 1. Anesthesia providers play a crucial role in minimizing distress and ensuring cooperation in patients with needle phobia through tailored strategies that encompass psychological support, pharmacologic interventions, and alternative anesthesia techniques.
A thorough preoperative assessment should include screening for needle phobia using patient history and direct questioning. Identifying past experiences with needles, the severity of anxiety, and associated physiological responses, such as syncope or panic attacks, allows for individualized management. Patients should be reassured that their concerns are recognized and that strategies will be implemented to reduce discomfort. Psychological preparation techniques such as cognitive-behavioral therapy, guided imagery, and distraction methods can be beneficial. Providing a calm environment and ensuring clear communication about the anesthesia plan can also help to alleviate any anticipatory anxiety 2–5.
Anesthesia providers can draw from several non-pharmacologic approaches to manage needle phobia. The use of topical anesthetics such as a lidocaine cream can numb the skin prior to intravenous placement, reducing a patient’s perception of pain 6. Distraction techniques, including breathing interventions, cognitive behavioral therapy, and conversation, may help divert attention from the needle 7. The use of desensitization techniques, where patients are gradually exposed to needle-related stimuli in a controlled manner with a therapist, can also be effective in long-term management 8. Finally, applying the “gate control theory” of pain by providing tactile stimulation near the injection site can help to reduce pain transmission 9.
For patients with severe needle phobia, pharmacologic interventions may be necessary to be able to proceed with anesthesia and surgery. Anxiolytics such as midazolam may be administered orally or intranasally prior to intravenous placement to induce relaxation. Inhaled nitrous oxide offers another effective option to provide anxiolysis and mild sedation without requiring intravenous access 10.
Postoperative management should prioritize minimizing distress and preventing patients from developing a deeper aversion to medical procedures. Many individuals, especially those with preexisting anxiety or negative past experiences, may be particularly vulnerable to heightened fear following surgery or other interventions. Healthcare providers should take a proactive approach by offering reassurance, providing clear explanations about recovery expectations, and ensuring that patients feel heard and supported throughout the healing process. Indeed, encouraging positive reinforcement can be highly effective in reshaping a patient’s perception of medical care. By acknowledging their resilience and highlighting moments of progress, healthcare professionals can help patients build confidence in their ability to handle future procedures. If necessary, referral to a psychologist specializing in phobia management may be beneficial for long-term care 5.
Effective anesthesia management for patients with needle phobia may involve a combination of psychological preparation, non-pharmacologic strategies, pharmacologic support, and alternative anesthesia techniques. An individualized, compassionate approach helps ensure patient cooperation and reduces perioperative stress, leading to improved overall surgical experiences. Healthcare providers should remain vigilant and adaptable to the needs of these patients, promoting a positive and anxiety-free perioperative environment.
References
1. Trypanophobia (Fear of Needles): Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/22731-trypanophobia-fear-of-needles.
2. Pre-operative assessment and patient preparation – the role of the anaesthetist. https://anaesthetists.org/Home/Resources-publications/Guidelines/Pre-operative-assessment-and-patient-preparation-the-role-of-the-anaesthetist-2.
3. García-Miguel, F. J. & Castillo, S. L. V. Preoperative anaesthesia assessment and patient preparation for surgery: update and a review. Medical Research Archives 12, (2024). DOI: 10.18103/mra.v12i4.5317
4. Powell, R. et al. Psychological preparation and postoperative outcomes for adults undergoing surgery under general anaesthesia. Cochrane Database Syst Rev 2016, CD008646 (2016). DOI: 10.1002/14651858.CD008646.pub2
5. CDC. Healthcare Providers: Understanding Needle Fears and Phobia. Disability and Health https://www.cdc.gov/disability-and-health/covid-19-resources/healthcare-providers-needle-phobia.html (2024).
6. Le May, S. et al. Topical anesthetics for needle-related pain in adults and children (TOPIC): a mini-review. Front Pain Res (Lausanne) 4, 1350578 (2024). DOI: 10.3389/fpain.2023.1350578
7. Birnie, K. A., Noel, M., Chambers, C. T., Uman, L. S. & Parker, J. A. Psychological interventions for needle‐related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2018, CD005179 (2018). DOI: 10.1002/14651858.CD005179.pub4
8. Taylor, G. D. & Campbell, C. A clinical guide to needle desensitization for the paediatric patient. Dent Update 42, 373–374, 377–378, 381–382 (2015). DOI: 10.12968/denu.2015.42.4.373
9. Malik, A. Distraction anaesthesia: Applying the gate control theory in delivering painless anaesthesia. Dental update 42, 97 (2015). DOI: 10.12968/denu.2015.42.1.97
10. Boyle, C. Managing phobic patients with conscious sedation. Vital 7, 14–15 (2010). DOI: 10.1038/vital1278