Pre-emptive ice cube cryotherapy for reducing pain from local anaesthetic injections for simple lacerations: a randomised controlled trial

• Published in: Emergency medicine journal : EMJ Vol. 35; no. 2; pp. 103 - 107
• Main Authors: Song, JaeWoo, Kim, HyukHoon, Park, EunJung, Ahn, Jung Hwan, Yoon, Eunhui, Lampotang, Samsun, Gravenstein, Nikolaus, Choi, SangChun
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2018
• Subjects: Adult; Analgesics; Analgesics - administration & dosage; Analgesics - pharmacology; Analgesics - therapeutic use; Anesthesia; Anesthesia, Local - methods; Anesthesia, Local - standards; Body temperature; Cold; Cryotherapy; Cryotherapy - methods; Data collection; Emergency medical care; Evidence-based medicine; Female; Humans; Ice; Information services; Injections, Subcutaneous - adverse effects; Lacerations - drug therapy; Lacerations - therapy; Local anesthesia; Male; Middle Aged; Pain; Pain - etiology; Pain Management - methods; Pain Management - standards; Pilot Projects; Prospective Studies; Sodium; Statistics, Nonparametric; Sutures; emergency department; pain management; wounds, treatment
• ISSN: 1472-0205; 1472-0213; 1472-0213
• DOI: 10.1136/emermed-2017-206585

ObjectiveSubcutaneous local anaesthetic injection can be painful to patients in the ED. We evaluated the effect of cryotherapy by application of an ice cube to the injection site prior to injection in patients with simple lacerations.MethodsWe conducted a prospective, randomised, controlled trial in consented patients with simple lacerations needing primary repair at a single emergency centre from April to July 2016. We randomly assigned patients undergoing repair for simple lacerations to either the cryotherapy group or the control group (standard care; no cryotherapy or other pretreatment of the injection site). In cryotherapy group subjects, we applied an ice cube (size: 1.5×1.5×1.5 cm) placed inside a sterile glove on the wound at the anticipated subcutaneous lidocaine injection site for 2 min prior to injection. The primary outcome was a subjective numeric rating (0–10 scale) of the perceived pain from the subcutaneous local anaesthetic injections. Secondary outcomes were (a) perceived pain on a numeric scale for cryotherapy itself, that is, pain from contact of the ice cube/glove with the skin and (b) the rate of complications after primary laceration repair.ResultsFifty patients were enrolled, consented and randomised, with 25 in the cryotherapy group and 25 in the control group. The numeric rating scale for subcutaneous anaesthetic injections was median, IQR, 95% CI 2.0 (1 to 3.5), 1.81 to 3.47, respectively, in the cryotherapy group and 5.0 (3 to 7), 3.91 to 6.05 in the control group (Mann-Whitney U=147.50, p=0.001). No wound complications occurred in either group. The numeric rating scale for cryotherapy itself was median, IQR, 95% CI: 2.0 (1 to 3.5), 1.90 to 3.70.ConclusionPre-emptive topical injection site cryotherapy lasting 2 min before subcutaneous local anaesthetic injections can significantly reduce perceived pain from subcutaneous local anaesthetic injections in patients presenting for simple laceration repair.Trial registration numberKCT0001990.