title: A Topical Anesthetic and Lidocaine Mixture for Pain Relief During Keloid Treatment: A Double-Blind, Randomized Controlled Trial.
abstract: BACKGROUND
  Keloids are abnormal overgrowth of collagen fibers, and the first-line treatment includes intralesional injection of triamcinolone acetonide (TA), which is associated with pain.
  
  
  OBJECTIVE
  To study the benefit of applying topical anesthetics or a 1:1 mixture of 1% lidocaine and TA at the TA injection site to alleviate pain during keloid treatment.
  
  
  METHODS
  A double-blind, randomized controlled trial was conducted. Four TA injection methods were tested: control, lidocaine, topical, and combined. A visual analog scale (VAS) was used to assess needle-stick and injection pain. Data on pain duration after injection were also collected.
  
  
  RESULTS
  Forty patients were enrolled (mean age, 37.1 years). The VAS scores of needle-stick pain in the control, lidocaine, topical, and combined groups were 4.18 ± 2.12, 3.82 ± 2.48, 2.03 ± 2.02, and 2.20 ± 1.99, respectively. Pain statistically decreased in the topical and combined groups. Intralesional injection pain (VAS) scores in the control, lidocaine, topical, and combined groups were similar as follows: 4.97 ± 2.50, 4.97 ± 2.79, 4.10 ± 2.80, and 4.43 ± 2.68, respectively.
  
  
  CONCLUSIONS
  Application of topical anesthetics significantly relieved needle-stick pain, especially at sternum and auricular keloids; administration of a lidocaine mixture did not alleviate pain during injection.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand.
authors.forename: Arnik
authors.initials: A
authors.lastname: Usanakornkul
authors.forename: Chairat
authors.initials: C
authors.lastname: Burusapat
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004311:Double-Blind Method; D054644:Ear Auricle; D005260:Female; D006801:Humans; D015552:Injections, Intralesional / Q000009:adverse effects; D007627:Keloid / Q000188:drug therapy*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D012782:Shoulder; D013909:Thorax; D014222:Triamcinolone Acetonide / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D008012:Lidocaine; D014222:Triamcinolone Acetonide