Local Anaesthetic Pain Reduction Techniques

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Solution Preparation

• Buffer the lidocaine with sodium bicarbonate.
• Warm the local anaesthetic

Equipment Factors

• Use fresh needles with repeated injections
• Use a small diameter needle

Patient Preparation

• Distraction
• Patient looks away

Reducing Needle Puncture Pain

• Topical anaesthetic creams
• Cooling with ice
• Tactile distraction
• Inject into subcutaneous fat if there is an open wound
• Insert needle perpendicularly to the skin

Reducing Injection Pain

• Stabilise the syringe holding hand to reduce needle movement
• Inject subdermally instead of intradermally
• Inject a small bleb and then pause
• Inject very slowly
• Keep the local anaesthetic wheal 10mm ahead of the needle tip
• Reinsert the needle only within 1cm of the blanched skin border
• Learn by asking all patient to score their injeciton pain

Resources

Minimizing the Pain of Local Anesthesia Injection - Strazar et al 2013 - 908 KB (f)

From the plastic surgery literature but many of the same principles apply