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Background: Surgeon administered local anesthesia with lidocaine and epinephrine can be minimally painful for patients undergoing carpal tunnel release. The purpose of this study is to evaluate the ability of learners to administer “Hole-in-One” local anesthesia (patient only feels one poke of pain).

Methods: Twenty-five consecutive medical students and residents were taught the “Hole-in-One” technique by the same surgeon. They then administered the anesthesia to the next patient and the patient then scored the learner’s ability to give local anesthetics using a questionnaire. 

Results: Medical students/residents are consistently capable of learning to administer local anesthetics with minimal pain. Seventy-six percent of the learners scored a “Hole-in-One” (patients felt pain once during injection) and 24% scored an “Eagle” (felt pain twice). There were no “Birdies” (felt pain 3 times). Most patients (88%) rated the whole pain experience less than or equal to 1/10. The majority (84%) rated the pain as better than injection pain at the dentist’s office, and 68% felt it was less sore than the needle for general anesthetic. All of the patients preferred local anesthesia to general anesthesia. None of the patients felt any pain during the surgical procedure.

Conclusion: Medical students and residents can quickly and reliably learn how to deliver minimal pain local anesthesia for carpal tunnel release. Costs and inconveniences of sedation, general anesthesia, and the tourniquet can be avoided with high patient satisfaction.