title: Effect of topical anesthetics on needle insertion pain during botulinum toxin type A injections for limb spasticity.
abstract: OBJECTIVE
  To compare pain perception using 3 anesthetics (eutectic mixture of local anesthetics [EMLA], vapocoolant spray, and ice) compared with a control (no anesthetic) during botulinum toxin type A (BTX-A) injections for lower limb spasticity.
  
  
  METHODS
  A placebo-controlled, single-blinded study where each study patient served as their own control.
  
  
  METHODS
  Spasticity clinic.
  
  
  METHODS
  Subjects (N=30) with ankle spasticity who visited the clinic for BTX-A injections in the gastrocnemius muscle were consecutively sampled.
  
  
  METHODS
  The gastrocnemius muscle was divided into 4 quadrants and 1 of the 3 different anesthetic agents was applied to each quadrant with 1 quadrant using no anesthetic, control.
  
  
  METHODS
  Numerical Rating Scale (NRS) and the Wong-Baker FACES scale.
  
  
  RESULTS
  Pain perception using the NRS and FACES scale was significantly lower using ice and EMLA compared with control and spray conditions (P<.05). Pain perception using EMLA and ice was similar. These results indicate that patients experience minimal to moderate pain during BTX-A injections.
  
  
  CONCLUSIONS
  Pain relief offered by EMLA and ice was comparable, suggesting that ice is a more convenient option because of brief application time (compared with EMLA). Spray may have made the patients more sensitive to pain and alternative approaches for using vapocoolant should be considered.
authors.affiliation: Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Sharon
authors.initials: S
authors.lastname: Fung
authors.forename: Chetan P
authors.initials: CP
authors.lastname: Phadke
authors.forename: Alice
authors.initials: A
authors.lastname: Kam
authors.forename: Farooq
authors.initials: F
authors.lastname: Ismail
authors.forename: Chris
authors.initials: C
authors.lastname: Boulias
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000842:Ankle; D001007:Anxiety / Q000517:prevention & control; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D003863:Depression / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods; D016037:Single-Blind Method
chemical_list: D000779:Anesthetics, Local; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A