Understanding Blood-Injection-Injury Phobia: Do Not Miss the Point

Needle and blood-injection-injury phobia is commonly encountered in the perioperative setting. It can significantly disrupt operating room throughput, increase healthcare costs, cause delays in care, and lead to patient disengagement with the healthcare system. These phobias, which involve intense fear and anxiety about needles and blood, can increase procedural risks, requiring interventions such as anxiolysis, sedation, and alternative behavioral health interventions to manage patient distress. Blood-injection-injury phobia is notably prevalent in females, with most individuals developing it during childhood. Genetic, environmental, and temperamental factors contribute to the development of blood-injection-injury phobia, with avoidance behavior often contributing to reinforcement and entrenchment of the phobia. blood-injection-injury phobia is more likely to be associated with syncope, compared to other phobias. When identified before surgery effective management strategies include cognitive-behavioral therapy and applied tension techniques. Early identification through screening and perhaps in the future, artificial intelligence-guided natural language screening of healthcare notes, can facilitate timely specialist referrals and improved multidisciplinary collaboration between anesthesiologists, nurses, and behavioral health specialists. On the day of surgery, techniques such as pharmacologic anxiolysis, topical anesthetics, vibration devices, and distraction can facilitate patient tolerance of needle-based procedures. Anesthesiologists receive little training in managing blood-injection-injury phobia. This narrative review discusses the characteristics, epidemiology, pathogenesis, significance, and offers management strategies for blood-injection-injury phobia during the presurgical and perioperative period.