Local and Regional Infiltrated Anesthesia (Excluding Topical Anesthesia)

  • Meredith Orseth
  • Divya Srivastava


The dermatologic indications for local and regional infiltrated anesthesia are abundant. Local infiltrative anesthesia is considered safe and effective for an array of procedures including excisions, biopsies, wound closures, skin grafting, cauterization, nonablative laser, and ablative skin resurfacing. Few contraindications to local and regional infiltrated anesthesia exist but should be screened for during the preoperative consultation. Numerous techniques for achieving adequate local and regional anesthesia have been described, including practices to lessen the pain associated with injection. Common side effects of local infiltrative anesthesia include pain, erythema, edema, bleeding, and ecchymoses. While overall well tolerated and commonly used, local and regional infiltrative anesthetic procedures do carry risks for toxicity and death. A comprehensive understanding of the pathophysiology, technique, and potential adverse events of various local and regional infiltrated anesthetics is critical to improve patient satisfaction and safety.


Local anesthesia Lidocaine Injectable Epinephrine Sodium bicarbonate Cutaneous surgery Systemic toxicity 


  1. 1.
    Kouba DJ, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016;74(6):1201–19.CrossRefPubMedGoogle Scholar
  2. 2.
    Ostad A, Kageyama N, Moy RL. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996;22(11):921–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16(3):248–63.CrossRefPubMedGoogle Scholar
  4. 4.
    Salam GA. Regional anesthesia for office procedures: part I. Head and neck surgeries. Am Fam Physician. 2004;69(3):585–90.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Paoli J, Halldin C, Sandberg C. Teaching peripheral nerve blocks for the head and neck area to dermatologists. J Eur Acad Dermatol Venereol. 2012;26(8):1035–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Walsh A, Walsh S. Local anaesthesia and the dermatologist. Clin Exp Dermatol. 2011;36(4):337–43.CrossRefPubMedGoogle Scholar
  7. 7.
    Vadoud-Seyedi J, Heenen M, Simonart T. Treatment of idiopathic palmar hyperhidrosis with botulinum toxin. Report of 23 cases and review of the literature. Dermatology. 2001;203(4):318–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Saedi N, et al. How to prepare patients for ablative laser procedures. J Am Acad Dermatol. 2013;69(2):e49.CrossRefPubMedGoogle Scholar
  9. 9.
    Wan K, et al. Application of a peripheral nerve block technique in laser treatment of the entire facial skin and evaluation of its analgesic effect. Eur J Dermatol. 2013;23(3):324–30.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Klein A, et al. Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial. Br J Dermatol. 2015;173(1):192–200.CrossRefPubMedGoogle Scholar
  11. 11.
    Halldin CB, et al. Nerve blocks enable adequate pain relief during topical photodynamic therapy of field cancerization on the forehead and scalp. Br J Dermatol. 2009;160(4):795–800.CrossRefPubMedGoogle Scholar
  12. 12.
    Serra-Guillen C, et al. Comparative study between cold air analgesia and supraorbital and supratrochlear nerve block for the management of pain during photodynamic therapy for actinic keratoses of the frontotemporal zone. Br J Dermatol. 2009;161(2):353–6.CrossRefPubMedGoogle Scholar
  13. 13.
    Lee EJ, Khandwala M, Jones CA. A randomised controlled trial to compare patient satisfaction with two different types of local anaesthesia in ptosis surgery. Orbit. 2009;28(6):388–91.CrossRefPubMedGoogle Scholar
  14. 14.
    Berde CB. Toxicity of local anesthetics in infants and children. J Pediatr. 1993;122(5 Pt 2):S14–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Covino BG. Pharmacology of local anaesthetic agents. Br J Anaesth. 1986;58(7):701–16.CrossRefPubMedGoogle Scholar
  16. 16.
    Ritchie JM, Ritchie B, Greengard P. The active structure of local anesthetics. J Pharmacol Exp Ther. 1965;150(1):152–9.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Hille B. The pH-dependent rate of action of local anesthetics on the node of Ranvier. J Gen Physiol. 1977;69(4):475–96.CrossRefPubMedGoogle Scholar
  18. 18.
    Bieter R. Applied pharmacology of local anesthetics. Am J Surg. 1936;34(3):500–10.CrossRefGoogle Scholar
  19. 19.
    Hruza G. Anesthesia. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. Spain: Elsevier; 2012. p. 2343–52.Google Scholar
  20. 20.
    Liu S, et al. Epinephrine prolongs duration of subcutaneous infiltration of local anesthesia in a dose-related manner. Correlation with magnitude of vasoconstriction. Reg Anesth. 1995;20(5):378–84.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Liem EB, et al. Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads. Anesthesiology. 2005;102(3):509–14.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Sadhasivam S, et al. Race and unequal burden of perioperative pain and opioid related adverse effects in children. Pediatrics. 2012;129(5):832–8.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bhole MV, et al. IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective. Br J Anaesth. 2012;108(6):903–11.CrossRefPubMedGoogle Scholar
  24. 24.
    Gall H, Kaufmann R, Kalveram CM. Adverse reactions to local anesthetics: analysis of 197 cases. J Allergy Clin Immunol. 1996;97(4):933–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Schatz M. Skin testing and incremental challenge in the evaluation of adverse reactions to local anesthetics. J Allergy Clin Immunol. 1984;74(4 Pt 2):606–16.CrossRefPubMedGoogle Scholar
  26. 26.
    Halabi-Tawil M, Kechichian E, Tomb R. An unusual complication of minor surgery: contact dermatitis caused by injected lidocaine. Contact Dermatitis. 2016;75(4):253–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Klotz U. Antiarrhythmics: elimination and dosage considerations in hepatic impairment. Clin Pharmacokinet. 2007;46(12):985–96.CrossRefPubMedGoogle Scholar
  28. 28.
    Rosen MR, Hoffman BF, Wit AL. Electrophysiology and pharmacology of cardiac arrhythmias. V. Cardiac antiarrhythmic effects of lidocaine. Am Heart J. 1975;89(4):526–36.CrossRefPubMedGoogle Scholar
  29. 29.
    Serrera Figallo MA, et al. Use of anesthetics associated to vasoconstrictors for dentistry in patients with cardiopathies. Review of the literature published in the last decade. J Clin Exp Dent. 2012;4(2):e107–11.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Niwa H, et al. Cardiovascular response to epinephrine-containing local anesthesia in patients with cardiovascular disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92(6):610–6.CrossRefPubMedGoogle Scholar
  31. 31.
    Fathi R, Serota M, Brown M. Identifying and managing local anesthetic allergy in dermatologic surgery. Dermatol Surg. 2016;42(2):147–56.CrossRefPubMedGoogle Scholar
  32. 32.
    Foster CA, Aston SJ. Propranolol-epinephrine interaction: a potential disaster. Plast Reconstr Surg. 1983;72(1):74–8.CrossRefPubMedGoogle Scholar
  33. 33.
    Berbaum MW, Bredle DL, Futamara W. Absence of significant adverse effects from low-dose subcutaneous epinephrine in dermatologic procedures. Arch Dermatol. 1997;133(10):1318–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Murase JE, Heller MM, Butler DC. Safety of dermatologic medications in pregnancy and lactation: part I. Pregnancy. J Am Acad Dermatol. 2014;70(3):401.e1–14. quiz 415.CrossRefGoogle Scholar
  35. 35.
    Rasmussen LF, Ahlfors CE, Wennberg RP. The effect of paraben preservatives on albumin binding of bilirubin. J Pediatr. 1976;89(3):475–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Minkis K, Whittington A, Alam M. Dermatologic surgery emergencies: complications caused by systemic reactions, high-energy systems, and trauma. J Am Acad Dermatol. 2016;75(2):265–84.CrossRefPubMedGoogle Scholar
  37. 37.
    Grekin RC, Auletta MJ. Local anesthesia in dermatologic surgery. J Am Acad Dermatol. 1988;19(4):599–614.CrossRefPubMedGoogle Scholar
  38. 38.
    Shalom A, et al. Complications of minor skin surgery performed under local anesthesia. Dermatol Surg. 2008;34(8):1077–9.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Sheldon RS, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12(6):e41–63.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Martin H, et al. Accidental Needlestick Exposures linked to the Administration of Local Anesthesia by Healthcare Workers. Infect Control Hosp Epidemiol. 2015;36(12):1487–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Bainbridge LC. Comparison of room temperature and body temperature local anaesthetic solutions. Br J Plast Surg. 1991;44(2):147–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: rate of administration and buffering. Ann Emerg Med. 1998;31(1):36–40.CrossRefPubMedGoogle Scholar
  43. 43.
    Fosko SW, Gibney MD, Harrison B. Repetitive pinching of the skin during lidocaine infiltration reduces patient discomfort. J Am Acad Dermatol. 1998;39(1):74–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Al-Qarqaz F, et al. Using cold air for reducing needle-injection pain. Int J Dermatol. 2012;51(7):848–52.CrossRefPubMedGoogle Scholar
  45. 45.
    Al Shahwan MA. Prospective comparison between buffered 1% lidocaine-epinephrine and skin cooling in reducing the pain of local anesthetic infiltration. Dermatol Surg. 2012;38(10):1654–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Stewart JH, et al. Neutralized lidocaine with epinephrine for local anesthesia – II. J Dermatol Surg Oncol. 1990;16(9):842–5.CrossRefPubMedGoogle Scholar
  47. 47.
    Stewart JH, Cole GW, Klein JA. Neutralized lidocaine with epinephrine for local anesthesia. J Dermatol Surg Oncol. 1989;15(10):1081–3.CrossRefPubMedGoogle Scholar
  48. 48.
    Masters JE. Randomised control trial of pH buffered lignocaine with adrenaline in outpatient operations. Br J Plast Surg. 1998;51(5):385–7.CrossRefPubMedGoogle Scholar
  49. 49.
    French GM, Painter EC, Coury DL. Blowing away shot pain: a technique for pain management during immunization. Pediatrics. 1994;93(3):384–8.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Kleiber C, Harper DC. Effects of distraction on children’s pain and distress during medical procedures: a meta-analysis. Nurs Res. 1999;48(1):44–9.CrossRefPubMedGoogle Scholar
  51. 51.
    Salvaggio HL, Zaenglein AL. “Magic goggles”: a distraction technique for pediatric dermatology procedures. Pediatr Dermatol. 2012;29(3):387–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Fayers T, Morris DS, Dolman PJ. Vibration-assisted anesthesia in eyelid surgery. Ophthalmology. 2010;117(7):1453–7.CrossRefPubMedGoogle Scholar
  53. 53.
    Sharma P, Czyz CN, Wulc AE. Investigating the efficacy of vibration anesthesia to reduce pain from cosmetic botulinum toxin injections. Aesthet Surg J. 2011;31(8):966–71.CrossRefPubMedGoogle Scholar
  54. 54.
    Mally P, et al. Vibration anesthesia for the reduction of pain with facial dermal filler injections. Aesthet Plast Surg. 2014;38(2):413–8.CrossRefGoogle Scholar
  55. 55.
    Swinehart JM. The ice-saline-xylocaine technique. A simple method for minimizing pain in obtaining local anesthesia. J Dermatol Surg Oncol. 1992;18(1):28–30.CrossRefPubMedGoogle Scholar
  56. 56.
    Ghali S, et al. Effects of lidocaine and epinephrine on cutaneous blood flow. J Plast Reconstr Aesthet Surg. 2008;61(10):1226–31.CrossRefPubMedGoogle Scholar
  57. 57.
    McKee DE, et al. Optimal time delay between epinephrine injection and incision to minimize bleeding. Plast Reconstr Surg. 2013;131(4):811–4.CrossRefPubMedGoogle Scholar
  58. 58.
    Dunlevy TM, O’Malley TP, Postma GN. Optimal concentration of epinephrine for vasoconstriction in neck surgery. Laryngoscope. 1996;106(11):1412–4.CrossRefPubMedGoogle Scholar
  59. 59.
    Morganroth PA, et al. A randomized, double-blind comparison of the total dose of 1.0% lidocaine with 1:100,000 epinephrine versus 0.5% lidocaine with 1:200,000 epinephrine required for effective local anesthesia during Mohs micrographic surgery for skin cancers. J Am Acad Dermatol. 2009;60(3):444–52.CrossRefPubMedGoogle Scholar
  60. 60.
    Lalonde D, et al. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie project clinical phase. J Hand Surg Am. 2005;30(5):1061–7.CrossRefPubMedGoogle Scholar
  61. 61.
    Häfner HM, Röcken M, Breuninger H. Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures. J Dtsch Dermatol Ges. 2005;3(3):195–9.CrossRefPubMedGoogle Scholar
  62. 62.
    Häfner HM, et al. Changes in acral blood flux under local application of ropivacaine and lidocaine with and without an adrenaline additive: a double-blind, randomized, placebo-controlled study. Clin Hemorheol Microcirc. 2008;38(4):279–88.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Schnabl SM, et al. Clinical results for use of local anesthesia with epinephrine in penile nerve block. J Dtsch Dermatol Ges. 2014;12(4):332–9.PubMedPubMedCentralGoogle Scholar
  64. 64.
    Thomson CJ, Lalonde DH. Randomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block. Plast Reconstr Surg. 2006;118(2):429–32.CrossRefPubMedGoogle Scholar
  65. 65.
    Pate DA, et al. Safety of prefilled buffered lidocaine syringes with and without epinephrine. Dermatol Surg. 2016;42(3):361–5.CrossRefPubMedGoogle Scholar
  66. 66.
    Pascuet E, et al. Buffered lidocaine hydrochloride solution with and without epinephrine: stability in polypropylene syringes. Can J Hosp Pharm. 2009;62(5):375–80.PubMedPubMedCentralGoogle Scholar
  67. 67.
    Larson PO, et al. Stability of buffered lidocaine and epinephrine used for local anesthesia. J Dermatol Surg Oncol. 1991;17(5):411–4.CrossRefPubMedGoogle Scholar
  68. 68.
    Landsman L, Mandy SH. Adjuncts to scalp reduction surgery. Intraoperative tissue expanders and hyaluronidase. J Dermatol Surg Oncol. 1991;17(8):670–2.CrossRefPubMedGoogle Scholar
  69. 69.
    Wohlrab J, et al. Clinical trial for safety evaluation of hyaluronidase as diffusion enhancing adjuvant for infiltration analgesia of skin with lidocaine. Dermatol Surg. 2012;38(1):91–6.CrossRefPubMedGoogle Scholar
  70. 70.
    Clark LE, Mellette JR. The use of hyaluronidase as an adjunct to surgical procedures. J Dermatol Surg Oncol. 1994;20(12):842–4.CrossRefPubMedGoogle Scholar
  71. 71.
    Szépfalusi Z, et al. IgE-mediated allergic reaction to hyaluronidase in paediatric oncological patients. Eur J Pediatr. 1997;156(3):199–203.CrossRefPubMedGoogle Scholar
  72. 72.
    Kirby B, et al. Type I allergic reaction to hyaluronidase during ophthalmic surgery. Contact Dermatitis. 2001;44(1):52.CrossRefPubMedGoogle Scholar
  73. 73.
    Hung VS, Bodavula VK, Dubin NH. Digital anaesthesia: comparison of the efficacy and pain associated with three digital nerve block techniques. J Hand Surg Br. 2005;30(6):581–4.CrossRefPubMedGoogle Scholar
  74. 74.
    Hill RG, et al. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Ann Emerg Med. 1995;25(5):604–7.CrossRefPubMedGoogle Scholar
  75. 75.
    Cannon B, et al. Digital anaesthesia: one injection or two? Emerg Med J. 2010;27(7):533–6.CrossRefPubMedGoogle Scholar
  76. 76.
    Keramidas EG, et al. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Plast Reconstr Surg. 2004;114(5):1131–4. discussion 1135–6.CrossRefPubMedGoogle Scholar
  77. 77.
    Yin ZG, et al. A comparison of traditional digital blocks and single subcutaneous palmar injection blocks at the base of the finger and a meta-analysis of the digital block trials. J Hand Surg Br. 2006;31(5):547–55.CrossRefPubMedGoogle Scholar
  78. 78.
    Chowdhry S, et al. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126(6):2031–4.CrossRefPubMedGoogle Scholar
  79. 79.
    Krunic AL, et al. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol. 2004;51(5):755–9.CrossRefPubMedGoogle Scholar
  80. 80.
    Bartfield JM, Jandreau SW, Raccio-Robak N. Randomized trial of diphenhydramine versus benzyl alcohol with epinephrine as an alternative to lidocaine local anesthesia. Ann Emerg Med. 1998;32(6):650–4.CrossRefPubMedGoogle Scholar
  81. 81.
    Waldbillig DK, et al. Randomized double-blind controlled trial comparing room-temperature and heated lidocaine for digital nerve block. Ann Emerg Med. 1995;26(6):677–81.CrossRefPubMedGoogle Scholar
  82. 82.
    Whiteley B, Rees S. A randomized controlled trial to compare two techniques for partial digital local anesthetic blocks. J Foot Ankle Surg. 2010;49(2):143–6.CrossRefPubMedGoogle Scholar
  83. 83.
    Starling J, Thosani MK, Coldiron BM. Determining the safety of office-based surgery: what 10 years of Florida data and 6 years of Alabama data reveal. Dermatol Surg. 2012;38(2):171–7.CrossRefPubMedGoogle Scholar
  84. 84.
    Habbema L. Efficacy of tumescent local anesthesia with variable lidocaine concentration in 3430 consecutive cases of liposuction. J Am Acad Dermatol. 2010;62(6):988–94.CrossRefPubMedGoogle Scholar
  85. 85.
    Burk RW, Guzman-Stein G, Vasconez LO. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg. 1996;97(7):1379–84.CrossRefPubMedGoogle Scholar
  86. 86.
    Kaplan B, Moy RL. Comparison of room temperature and warmed local anesthetic solution for tumescent liposuction. A randomized double-blind study. Dermatol Surg. 1996;22(8):707–9.CrossRefPubMedGoogle Scholar
  87. 87.
    Hanke CW, et al. Infusion rates and levels of premedication in tumescent liposuction. Dermatol Surg. 1997;23(12):1131–4.CrossRefPubMedGoogle Scholar
  88. 88.
    Neal JM, et al. ASRA practice advisory on local anesthetic systemic toxicity. Reg Anesth Pain Med. 2010;35(2):152–61.CrossRefPubMedGoogle Scholar
  89. 89.
    Nagel JE, Fuscaldo JT, Fireman P. Paraben allergy. JAMA. 1977;237(15):1594–5.CrossRefPubMedGoogle Scholar
  90. 90.
    Wentworth AB, et al. Trends in patch-test results and allergen changes in the standard series: a Mayo Clinic 5-year retrospective review (January 1, 2006, to December 31, 2010). J Am Acad Dermatol. 2014;70(2):269–75. e4.CrossRefPubMedGoogle Scholar
  91. 91.
    TO D, Kossintseva I, de Gannes G. Lidocaine contact allergy is becoming more prevalent. Dermatol Surg. 2014;40(12):1367–72.CrossRefPubMedGoogle Scholar
  92. 92.
    Di Gregorio G, et al. Clinical presentation of local anesthetic systemic toxicity: a review of published cases, 1979 to 2009. Reg Anesth Pain Med. 2010;35(2):181–7.CrossRefPubMedGoogle Scholar
  93. 93.
    Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90–101. quiz 102–3.CrossRefPubMedPubMedCentralGoogle Scholar
  94. 94.
    Moore DC, Bridenbaugh LD. Oxygen: the antidote for systemic toxic reactions from local anesthetic drugs. JAMA. 1960;174:842–7.CrossRefPubMedGoogle Scholar
  95. 95.
    Alam M, et al. Safety of peak serum lidocaine concentration after Mohs micrographic surgery: a prospective cohort study. J Am Acad Dermatol. 2010;63(1):87–92.CrossRefPubMedGoogle Scholar
  96. 96.
    Bernstein G, Hanke CW. Safety of liposuction: a review of 9478 cases performed by dermatologists. J Dermatol Surg Oncol. 1988;14(10):1112–4.CrossRefPubMedGoogle Scholar
  97. 97.
    Steinberg MD, Block P. The use and abuse of epinephrine in local anesthetics. J Am Podiatry Assoc. 1971;61(9):341–3.CrossRefPubMedGoogle Scholar
  98. 98.
    Hasse AL, Heng MK, Garrett NR. Blood pressure and electrocardiographic response to dental treatment with use of local anesthesia. J Am Dent Assoc. 1986;113(4):639–42.CrossRefPubMedGoogle Scholar
  99. 99.
    Goodacre TE, et al. Split skin grafting using topical local anaesthesia (EMLA): a comparison with infiltrated anaesthesia. Br J Plast Surg. 1988;41(5):533–8.CrossRefPubMedGoogle Scholar
  100. 100.
    Eidelman A, et al. Comparative efficacy and costs of various topical anesthetics for repair of dermal lacerations: a systematic review of randomized, controlled trials. J Clin Anesth. 2005;17(2):106–16.CrossRefPubMedGoogle Scholar
  101. 101.
    Armstrong P, Young C, McKeown D. Ethyl chloride and venepuncture pain: a comparison with intradermal lidocaine. Can J Anaesth. 1990;37(6):656–8.CrossRefPubMedGoogle Scholar
  102. 102.
    Selby IR, Bowles BJ. Analgesia for venous cannulation: a comparison of EMLA (5 minutes application), lignocaine, ethyl chloride, and nothing. J R Soc Med. 1995;88(5):264–7.PubMedPubMedCentralGoogle Scholar
  103. 103.
    Abbott K, Fowler-Kerry S. The use of a topical refrigerant anesthetic to reduce injection pain in children. J Pain Symptom Manag. 1995;10(8):584–90.CrossRefGoogle Scholar
  104. 104.
    Ernst AA, et al. Comparison trial of four injectable anesthetics for laceration repair. Acad Emerg Med. 1996;3(3):228–33.CrossRefPubMedGoogle Scholar
  105. 105.
    Xia Y, et al. Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection. J Clin Anesth. 2002;14(5):339–43.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Meredith Orseth
    • 1
  • Divya Srivastava
    • 1
  1. 1.University of Texas Southwestern Medical CenterDallasUSA

Personalised recommendations