Effect of LI4 Acupressure on Pain and Distress during Intramuscular Injection in Infants: A Randomised Controlled Study

Abstract

Introduction: Intramuscular injections are common procedures in infancy and may be associated with pain, crying, distress, and behavioral responses. Simple, safe, and feasible non-pharmacological interventions are required to support infant comfort during routine clinical procedures. LI4 acupressure has been proposed as a brief pressure-based intervention that may influence pain perception through tactile stimulation. Aim: This study aimed to evaluate the effect of LI4 acupressure on pain and distress among infants receiving intramuscular injections. Methods: A post-test-only control group design was adopted. Sixty infants who met the study criteria were enrolled and allocated to an intervention group and a standard control group, with 30 infants in each group, using the sequentially numbered opaque sealed envelope method. The study was conducted in the pediatric outpatient department of AJ Hospital and Research Centre, Mangalore, Karnataka. In the intervention group, acupressure was applied at the LI4 area with the investigator's thumb for 30 seconds, five minutes before intramuscular injection. Pain and distress during and after injection were assessed using the Neonatal Infant Pain Scale and Infant Distress Scale. Data were analyzed using SPSS version 23. Results: Infants in both groups experienced severe pain and distress during injection. After injection, the intervention group showed lower pain and distress scores than the standard control group. Pain scores differed significantly during injection (t = 3.793, p < 0.01) and one minute after injection (t = 2.583, p < 0.01). Distress scores also differed significantly during injection (t = 2.851, p < 0.01). No significant difference in pain was observed five minutes after injection. Conclusion: LI4 acupressure before intramuscular injection may help reduce immediate pain and distress responses among infants and may be considered as a simple supportive measure during routine injections.