Overview
Local anesthetic injection is often cited as the most painful part of minor procedures. The authors aimed to show how to inject local anesthesia in an almost pain-free manner. They reviewed the literature from 1950 to August 2012 and asked over 500 patients to score injectors by the number of times they felt pain during the injection.
Findings
- Literature reviewed from 1950 to August 2012.
- Over 500 patients reported how many times they felt pain during injection.
- Methods are grouped in the order of an injection: solution selection and preparation, equipment choices, patient education, topical site preparation, and procedural technique.
- Supporting evidence ranges from anecdotal to systematic reviews.
- Medical students and residents can learn techniques that limit injection pain to the first fine needlestick.
- Combining these techniques, tumescent local anesthetic can be given to a large area, such as a face for rhytidectomy, with the patient feeling only the initial poke.
What it means for a patient
- A face lift can be done under tumescent local anesthesia, and the authors state the injection can be given with the patient feeling only the first needle poke.
- Pain from local anesthetic depends on how it is prepared and injected, not only on the drug. These are steps a surgeon can learn.
- It is reasonable to ask a surgeon how they reduce injection pain.
- Limits: this is a review and the abstract gives no pain scores or comparisons. Evidence behind individual techniques varies from anecdotal to systematic reviews.
Why this paper matters
It gathers pain-reducing injection methods into one ordered sequence and states they allow large areas, including the face for rhytidectomy, to be numbed with only one felt needlestick. Cited 125 times (NIH iCite, 2026-09-25).
Terms
- Local anesthesia: numbing medicine injected into one area so the patient stays awake without feeling pain there.
- Tumescent local anesthesia: a large volume of dilute anesthetic solution injected to swell and numb a wide area.
- Rhytidectomy: a face lift.
- Topical site preparation: treating the skin surface before the needle goes in.
- Systematic review: a study that gathers and grades all published research on one question.
- Anecdotal evidence: evidence from personal experience rather than from controlled study.