Effectiveness of 2% Lidocaine Combined with Acupressure on Anxiety, Stress, and Pain Levels During Pleural Puncture Procedures
DOI:
https://doi.org/10.26911/theijmed.2026.11.2.940Abstract
Background: Pleural puncture (thoracentesis) often causes anxiety, stress, and pain. Although 2% lidocaine is commonly used for analgesia, its effect on psychological distress is limited. Acupressure may help reduce both pain and emotional discomfort. This study evaluated the effectiveness of 2% lidocaine combined with acupressure in patients undergoing pleural puncture.
Subjects and Method: A randomized controlled trial was conducted on 36 patients undergoing pleural puncture at Dr. Moewardi Regional General Hospital, Surakarta, Indonesia. Patients were allocated to three groups: Control (2% lidocaine 4 cc), Treatment 1 (2% lidocaine 4 cc + acupressure), and Treatment 2 (2% lidocaine 2 cc + acupressure). Acupressure was applied 20 minutes prior to the procedure at points PC6, Yintang (EX-HN3), Hegu (LI4), and Baihui (GV20). Anxiety, stress, and pain were assessed using DASS-21 and Numeric Rating Scale (NRS) before and after the procedure. Data were analyzed using Shapiro-Wilk normality test, Levene homogeneity test, ANOVA, paired t-test, and post hoc LSD test.
Results: Anxiety scores were lower in treatment 1 (Mean=5.66; SD=2.38) and treatment 2 (Mean= 5.16; SD=2.48) than in the control group (Mean=8.00; SD=3.07; p=0.009). Stress scores were also lower in treatment 1 (Mean=4.50; SD=2.27) and treatment 2 (Mean=4.33; SD=2.53) versus control (Mean=7.16; SD=3.01; p=0.001). Pain scores were reduced in treatment 1 (Mean=1.50; SD=1.31) and treatment 2 (Mean=1.33; SD=0.88) compared with control (Mean=2.91; SD=1.67; p=0.036). No significant differences were found between treatment groups (p>0.05).
Conclusion: Acupressure combined with 2% lidocaine effectively reduces anxiety, stress, and pain during pleural puncture. Lower-dose lidocaine provided comparable outcomes when combined with acupressure.
Keywords:
anxiety, lidocaine, pleural, pleural puncture, pain
References
Alizadeh T, Takasi P (2024). Effect of acupressure on the anxiety and pain of patients undergoing cardiac cathe-terization: A systematic review. J Nurs Rep Clin Pract. 2(2): 74–81. https://doi.org/10.32598/JNRCP.2401.1010.
Barcelon E, Chung S, Lee J, Lee S (2023). Sexual dimorphism in the mechanism of pain central sensitization. Cells. 12(16): 2028. https://doi.org/10.3390/cells1216-2028
Bastani F, Hajizadeh S, Sa'atchi K, Haghani H (2016). Comparing the effect of acupressure and cryotherapy on the pain caused by removal of chest drain tube in the elderly patients undergoing open heart surgery. J Client-Centered Nurs Care. 2(1): 37–52. https://doi.org/10.32598/jccnc.2.1.37
Dahmardeh H (2024). The effect of acu-pressure on pain associated with chest tube removal in patients with chest trauma. Arch Anesth Crit Care. 10(1): 499-504. https://doi.org/10.-18502/aacc.v10is1.17201.
Diyanto D, Febryandy V, Irawan AG (2023). Efektivitas penerapan acu-pressure terhadap kualitas hidup pasien selama hemodialisis: Sistem-atik review dan meta-analisis. Indo-nes J Nurs Sci Pract. 6(1): 27–34. https://doi.org/10.24853/ijnsp.v6i1.27-34.
Du A, Hannan L, Muruganandan S (2023). A narrative review on pain control interventions for non-surgical pleural procedures. Respir Med. 207: 107119. https://doi.org/10.1016/j.rmed.2023.107119.
Duzova US, Can G, Duzova M, Basaran H, Yavas C (2025). The effect of acupressure on anxiety, depression, pain, and vital signs in gynecological cancer patients receiving brachy-therapy: A randomized controlled study. Support Care Cancer. 33(8): 698. https://doi.org/10.1007/s0052-0-025-09754-6.
Focks C (2008). Acupuncture point of the twelve primary channels. In: McG K, Martin M, editors. Atlas of Acupunc-ture. 1st ed. London: Churchill Livingstone. https://books.google.-co.id/books/about/Atlas_of_-Acupuncture.-html?id=rpNEcr4H31cC&hl=id.
Goncharova N, Chigarova O, Oganyan T (2023). Age-related and individual features of the HPA axis stress responsiveness under constant light in nonhuman primates. Front Endo-crinol. 13: 1083636. doi:10.3389/-fendo.2022.1083636
Halili H, Azizkhani R, Tavakoli Garmaseh S, Jafarpisheh MS, Heydari F, Masoumi B (2020). Comparing the effect of lidocaine-prilocaine cream and infiltrative lidocaine on overall pain perception during thoracentesis and abdominocentesis: A randomized clinical trial. Anesthesiol Pain Med. 11(1): e106275. https://doi.org/-10.5812/aapm.106275.
Ministry of Health of the Republic of Indonesia. (2023). Indonesia Health Profile 2022. Jakarta: Ministry of Health of the Republic of Indonesia. [in Indonesian language]. Retrieved from https://kemkes.go.id/id/indo-nesia-health-profile-2022.
Krishna R, Antoine MH, Alahmadi MH, Rudrappa M (2024). Pleural effusion. StatPearls. https://www.ncbi.nlm.nih.gov/-books/NBK448189/
Kudielka B, Kirschbaum C (2005). Sex differences in HPA axis responses to stress: A review. Biol Psychol. 69(1): 113–132. https://doi.org/10.1016/j.biopsycho.-2004.11.009.
Kwon C, Lee B (2018). Yintang (EX-HN3) for anxiety: A preliminary review. Med Acupunct. 30(2): 73–79. https:-//doi.org/10.1089/acu.2017.1256
Liu L, Zhao G, Dou Y, Li L, Chen P, Li T, Gao M (2023). Analgesic effects of perioperative acupuncture methods: A narrative review. Medicine (Balti-more). 102(43): e35759. https://doi.-org/10.1097/MD.00000000000357-59.
Mostafa M, Fathallah M (2020). Effective-ness of acupressure in the reduction of pain and anxiety among patients with open thoracotomy. Am J Nurs Res. 8(2): 182–191. https://doi.org-/10.12691/ajnr-8-2-7.
Mulugeta H, Ayana M, Sintayehu M, Dessie G, Zewdu T (2018). Preoperative anxiety and associated factors among adult surgical patients in Debre Markos and Felege Hiwot referral hospitals, Northwest Ethiopia. BMC Anesthesiol. 18: 155. https://doi.org/10.1186/s12871-018-0619-0.
Sharifi RM, Shamsalinia A, Ghaffari F, Keyhanian S, Naderi Nabi B (2017). The effect of acupressure on pain, anxiety, and the physiological indexes of patients with cancer undergoing bone marrow biopsy. Complement Ther Clin Pract. 29: 136–141. https://-doi.org/10.1016/j.ctcp.2017.09.002.
Shechtman L, Shrem M, Kleinbaum Y, Bornstein G, Gilad L, Grossman C (2020). Incidence and risk factors of pneumothorax following pre-proce-dural ultrasound-guided thorac-entesis. J Thorac Dis. 12(3): 942–948. https://doi.org/10.21037/jtd.2019.12.39.
Shewangzaw EA, Belay YH, Alemnew EN, Admasu BE, Adem A, Dargie WA (2022). Magnitude of preoperative anxiety and associated factors among adult surgical patients in Debre Berhan Comprehensive Specialized Hospital. Int J Gen Med. 15: 5999–6007. https://doi.org/10.2147/IJGM-.S369921.
Silva A, Mourão J, Vale N (2023). A review of lidocaine in the perioperative period. J Pers Med. 13(12): 1699. https://doi.org/10.3390/jpm13121699.
Sutanto YS, Sigit I, Kurniawan H (2020). The relationship of amount of pleural fluid and time of pleurodesis with the results of pleurodesis in malignant pleural effusions. Indones J Med. 5(4): 337–342. https://doi.org/10.26911/theijmed.-2020.05.04.09.
Zhi Y, Zhang Y, Zhang Y, Zhang M, Kong Y (2024). Age-associated changes in multimodal pain perception. Age Ageing. 53(5): afae091. https://doi.-org/10.1093/ageing/afae091.
