Intralesional corticosteroid injections with lidocaine more painful

Adding lidocaine to intralesional corticosteroid injections caused more pain compared with corticosteroid injections mixed with saline, according to a poster presented at the American Academy of Dermatology virtual meeting.

“Due to an acidic pH of 4.7, lidocaine with epinephrine causes a burning sensation during infiltration, and this may be a significant component of associated injection pain,” the study authors wrote.

The prospective, double-blind, randomized controlled trial included 31 patients randomly assigned to receive triamcinolone acetonide and lidocaine with 1:100,000 epinephrine or triamcinolone acetonide and 0.9% normal saline.

Patients received injections for alopecia, psoriasis, keloid and other dermatological conditions.

A statistically significant difference in pain outcomes, as measured by the Wong-Baker visual analog scale, was recorded. Those in the steroid and lidocaine group had a VAS score immediately after injection of 5.4 compared with a VAS score of 2.7 for those in the steroid and saline group (P = .0056).

Differences in pain scores at 6 hours and 24 hours after injection were not statistically significant.

“Corticosteroid injections with lidocaine are more painful than those mixed with saline,” the authors wrote. “Local anesthetic adds unnecessary cost and potential risks to the injection.”