Corticosteroid Injections Mixed with Lidocaine are More Painful for Patients with Dermatologic Conditions

Typically, corticosteroids are administered as a mixture with either saline or local anesthetic, usually lidocaine with epinephrine. However, lidocaine plus epinephrine can cause a burning sensation and may be a significant component of injection-site pain. Researchers found that corticosteroid injections with lidocaine were more painful than those mixed with saline, and use of local anesthetic adds unnecessary costand potential risks to the injection. The results of the study were published as part of the American Academy of Dermatology Virtual Meeting Experience 2020.

The prospective, double-blind, randomized, controlled trial included 31 patients aged older than 12 years presenting to the Vanderbilt University Medical Center dermatology clinics. Patients with a contraindication to corticosteroid injection were excluded. Patients received either triamcinolone acetonide plus lidocaine with 1:100,000 epinephrine (n=13; mean age, 33 years) or triamcinolone acetonide plus 0.9% normal saline (n=18; mean age, 52 years). Injection was performed with a 5-mL syringe and 30-gauge needle.

Patient indications included alopecia (n=8), psoriasis (n=6), keloid (n=6), and “other” (n=9; which included hypertrophic scar, lichen simplex chronicus, abscess, eczema, morphea, and hidradenitis suppurativa). The primary endpoint was visual analog scale (VAS) pain score immediately, six hours, and 24 hours after injection.

There was a statistically significant difference in pain outcomes between corticosteroid injections mixed with lidocaine with epinephrine versus those mixed with saline immediately after injection: VAS pain scores were 5.4 in the steroid plus lidocaine and epinephrine group versus 2.7 in the steroid and normal saline group (P=0.0056). VAS pain scores decreased in both cohorts at six- and 24-hours post-injection. There were no adverse events in either treatment cohort.

“We recommend administering injectable corticosteroid solutions without adding lidocaine,” the researchers concluded.

Zakria D, Patrinely Jr JR, Dewan AK, et al. Use of Local Anesthetic for Intralesional Corticosteroid Injections; A Double Blind; Randomized Controlled Trial. Presented during the AAD Virtual Meeting Experience 2020, June 12-14, 2020.