title: Use and Effectiveness of Ethyl Chloride for Hand Injections.
abstract: OBJECTIVE
  Limited literature supports using ethyl chloride topical spray as an anesthetic for hand injections whereas documented risks include frostbite, skin irritation, and inhalation toxicity. We hypothesize that ethyl chloride spray imparts no benefit to patients' perception of pain or anxiety for routine hand injections.
  
  
  METHODS
  We first surveyed all members of the American Society for Surgery of the Hand to discern the prevalence of ethyl chloride use during routine injections. We then performed a prospective, randomized, study at 2 institutions evaluating the efficacy of ethyl chloride spray compared with "routine injection" (no topical spray) in patients indicated for a hand injection. All patients completed a pre- and postinjection 11-point questionnaire that inquired about various components of pain and anxiety.
  
  
  RESULTS
  A total of 2,083 (73% response rate) American Society for Surgery of the Hand members responded to the survey and revealed that 59% of hand surgeons always or often use ethyl chloride, and 24% never use it. There were no differences for region or practice setting, but experienced surgeons were less likely to routinely use ethyl chloride (35%) compared with younger surgeons (66%). Among 151 patients participating in the clinical study (75 with ethyl chloride), there were no differences for any outcome measure assessed. Injection pain in the spray and no-spray groups, pain after 1 minute, and overall anxiety were equivalent. Subgroup analysis demonstrated no effect of sex, anticipated anxiety, or pain threshold.
  
  
  CONCLUSIONS
  Ethyl chloride is widely used among hand surgeons but imparts no benefit for routine hand injections in the clinical setting. The potential risks and costs of ethyl chloride use may outweigh its benefits.
  
  
  METHODS
  Therapeutic II.
authors.affiliation: East Bay Hand Medical Center, San Leandro, CA. Electronic address: DrFranko@ebhmc.com.
authors.forename: Orrin I
authors.initials: OI
authors.lastname: Franko
authors.affiliation: Department of Orthopedic Surgery, University of Cincinnati, Cincinnati, OH.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Stern
mesh_terms: D000287:Administration, Topical; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001007:Anxiety; D017679:Cryotherapy; D005018:Ethyl Chloride / Q000008:administration & dosage*; D005260:Female; D006225:Hand / Q000601:surgery*; D019538:Health Care Surveys; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010465:Perception; D011300:Preoperative Care; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D005018:Ethyl Chloride
keywords: Ethyl chloride; carpal tunnel; injections; trigger finger; vapocoolant