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Arch Phys Med Rehabil. 2012 Sep;93(9):1643-7. doi: 10.1016/j.apmr.2012.03.012. Epub 2012 Mar 23.

Effect of topical anesthetics on needle insertion pain during botulinum toxin type A injections for limb spasticity.

Author information

1
Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Abstract

OBJECTIVE:

To compare pain perception using 3 anesthetics (eutectic mixture of local anesthetics [EMLA], vapocoolant spray, and ice) compared with a control (no anesthetic) during botulinum toxin type A (BTX-A) injections for lower limb spasticity.

DESIGN:

A placebo-controlled, single-blinded study where each study patient served as their own control.

SETTING:

Spasticity clinic.

PARTICIPANTS:

Subjects (N=30) with ankle spasticity who visited the clinic for BTX-A injections in the gastrocnemius muscle were consecutively sampled.

INTERVENTION:

The gastrocnemius muscle was divided into 4 quadrants and 1 of the 3 different anesthetic agents was applied to each quadrant with 1 quadrant using no anesthetic, control.

MAIN OUTCOME MEASURES:

Numerical Rating Scale (NRS) and the Wong-Baker FACES scale.

RESULTS:

Pain perception using the NRS and FACES scale was significantly lower using ice and EMLA compared with control and spray conditions (P<.05). Pain perception using EMLA and ice was similar. These results indicate that patients experience minimal to moderate pain during BTX-A injections.

CONCLUSIONS:

Pain relief offered by EMLA and ice was comparable, suggesting that ice is a more convenient option because of brief application time (compared with EMLA). Spray may have made the patients more sensitive to pain and alternative approaches for using vapocoolant should be considered.

PMID:
22449552
DOI:
10.1016/j.apmr.2012.03.012
[Indexed for MEDLINE]

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