Lidocaine injection for trigger finger linked with more pain without delayed benefits of pain relief vs placebo

BOSTON — Patients with trigger finger who received an injection of lidocaine with corticosteroid experienced more pain without significant delayed benefits of pain relief compared to a placebo group, according to results presented here.

“Based on our findings, we can conclude that lidocaine results in greater injection pain, has no effect on acute pain within a 72-hour window and, from the literature, we know it has no influence on the efficacy of treatment, but it does add cost, time and risk,” Shepard Peir Johnson, MBBS, said in his presentation at the American Society for Surgery of the Hand Annual Meeting.

Johnson and colleagues randomly assigned 73 patients with trigger finger to 110 injections of either 1 mL of triamcinolone plus 1 mL of 1% lidocaine (n=57) or 1 mL of triamcinolone plus 1 mL of 0.9% saline (n=53).

“We then evaluated pain scores with a visual analogue scale from 0 to 10,” Johnson said. “This was asked immediately after the procedure and then at 6-, 24- and 72-hour time points via phone call.”

After the injection, patients who received lidocaine experienced clinically and significantly more immediate pain with a VAS score of 3.5 vs. 2 in the placebo group, according to Johnson.

“As time progressed, pain decreased in both cohorts and there were no statistical differences at those three time points,” Johnson said. “Of note, there was no complication in either of the cohorts at 6-week follow-up.”

To help reduce injection pain, Johnson noted surgeons should provide patients with “pre-procedural education to address anxiety and fear of the treatment.”

“We can borrow the recommendations from the World Health Organization, who have released best evidence to minimize pain during injection procedures, such as immunizations or blood draws,” Johnson said. “They recommend that the provider use calm language, place the patient in a relaxed position and use distracting techniques, such as breathing exercises.” – by Casey Tingle

Reference:

Patrinely JR Jr., et al. Paper 64. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 13-15, 2018; Boston.

Disclosure: Johnson reports no relevant financial disclosures.