title: A Clinical Comparison of EMLA Cream and Ethyl Chloride Spray Application for Pain Relief of Forehead Botulinum Toxin Injection.
abstract: OBJECTIVE
  This study aims to analyze the efficiency of EMLA cream and ethyl chloride spray application for pain alleviation before botulinum toxin injection.
  
  
  METHODS
  Forty-five patients were divided into 3 treatment groups. Skin cooling with ethyl chloride spray (in group 1), topical anesthetic cream (EMLA) (in group 2), was used on the forehead area on one side previous to injection; the opposite side served as the control. In the third group (n = 15), cold was applied using ethyl chloride spray to one side, and to the other side topical anesthetic cream (EMLA) was applied. A visual analog scale was used for pain intensity.
  
  
  RESULTS
  In the first group, the average pain score was 3.20 ± 1.20 on the side where ethyl chloride spray was applied and 7.26 ± 1.94 on the control side (P < 0.05). It was 4.20 ± 1.37 on the side receiving EMLA and 7.66 ± 1.54 (P < 0.05) on the control side in the second group. In the third group, the average score was 6.80 ± 1.37 for the EMLA side and 2.93 ± 1.03 for the ethyl chloride sprayed side (P < 0.05).
  
  
  CONCLUSIONS
  Skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.
authors.affiliation: From the Department of Plastic and Reconstructive Surgery, Adnan Menderes University Faculty of Medicine, Aydin, Turkey.
authors.forename: Saime
authors.initials: S
authors.lastname: Irkoren
authors.forename: Heval Selman
authors.initials: HS
authors.lastname: Ozkan
authors.forename: Huray
authors.initials: H
authors.lastname: Karaca
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D000336:Aerosols; D000779:Anesthetics, Local / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000009:adverse effects*; D003357:Cosmetic Techniques / Q000009:adverse effects*; D018592:Cross-Over Studies; D005018:Ethyl Chloride / Q000627:therapeutic use*; D005260:Female; D005546:Forehead; D006801:Humans; D007279:Injections, Subcutaneous; D008012:Lidocaine / Q000627:therapeutic use*; D000077442:Lidocaine, Prilocaine Drug Combination; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced / Q000175:diagnosis / Q000188:drug therapy*; D010147:Pain Measurement; D011318:Prilocaine / Q000627:therapeutic use*; D011446:Prospective Studies; D063465:Skin Cream; D016896:Treatment Outcome
chemical_list: D065087:Acetylcholine Release Inhibitors; D000336:Aerosols; D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D005018:Ethyl Chloride; D008012:Lidocaine; D019274:Botulinum Toxins, Type A