title: Warm and neutral tumescent anesthetic solutions are essential factors for a less painful injection.
abstract: BACKGROUND
  Tumescent local anesthesia is widely used in dermatologic surgery. Minimizing pain associated with injections is crucial to successful surgical procedures.
  
  
  OBJECTIVE
  This study investigates the pain associated with warm and room temperatures in neutralized or nonneutralized tumescent anesthetic solutions injection.
  
  
  METHODS
  Thirty-six patients with axilla osmidrosis who underwent local anesthesia for surgery were randomly assigned to three groups. Group A received warm neutral (40 degrees C) and room-temperature neutral (22 degrees C) tumescent injections to each axillary region. Group B received warm neutral (pH 7.35) and warm nonneutral (pH 4.78) tumescent injections on each side of axilla. Group C received warm nonneutral and room-temperature nonneutral tumescent injections on each side of axilla. Pain associated with infiltration of anesthesia was rated on a visual analog scale (VAS).
  
  
  RESULTS
  A statistically significant decrease (p < .001) in pain sensation was reported on the warm, neutral injection side (mean rating, 32.7 mm) compared with the room-temperature, neutral injection side (mean rating, 53.3 mm). Patient-reported pain intensity was significantly lower on the side that received warm, neutral tumescent anesthesia (mean rating, 26.8 mm) than on the side receiving warm, nonneutral tumescent anesthesia (mean rating, 44.9 mm; p < .001). The difference in VAS scores between warm neutral (mean rating, 23.9 mm) and room-temperature nonneutral (mean rating, 61.2 mm) was statistically significant (p < .001).
  
  
  CONCLUSIONS
  The warm, neutral tumescent anesthetic preparation effectively suppressed patient pain during dermatologic surgical procedures.
authors.affiliation: Department of Dermatology, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Yang
authors.forename: Hsiu-Cheng
authors.initials: HC
authors.lastname: Hsu
authors.forename: Su-Chin
authors.initials: SC
authors.lastname: Shen
authors.forename: Wei-Hsin
authors.initials: WH
authors.lastname: Juan
authors.forename: Hong-Shang
authors.initials: HS
authors.lastname: Hong
authors.forename: Chien-Hsun
authors.initials: CH
authors.lastname: Chen
mesh_terms: D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001365:Axilla; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D015187:Lipectomy / Q000379:methods; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D012189:Retrospective Studies; D013696:Temperature; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local