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Lidocaine Administration for Preinjection Anesthesia in Trigger Finger Injections: A randomized controlled clinical trial
Sofia Bougioukli, MD, PhD
1; Luke Nicholson, MD
2; Haley Nakata, MD
3; Pui Yan, MS
3; Charalampos Zalavras, MD, PhD
3; Milan Stevanovic, MD, PhD
3; Rachel Lefebvre, MD
41University of Michigan, Ann Arbor, MI; 2University of Southern California/LAC+USC Medical Center, Los Angeles, CA; 3University of Southern California, Los Angeles, CA; 4Watson clinic, Lakeland, FL
Introduction:
In this study we propose pre-injection anesthesia with lidocaine to control the pain associated with intrasheath injections for trigger finger. We aim to evaluate whether patients who have a local anesthetic injection prior to intrasheath corticosteroid+lidocaine injection achieve better pain control versus those who receive corticosteroid+lidocaine intrasheath injection alone. Materials&methods:
This was a randomized controlled clinical trial in adult patients with trigger finger of a single digit(Fig1). Patients were randomized to receive either a)single intrasheath injection of corticosteroid+lidocaine or b)two injections;a subdermal injection of lidocaine followed by intrasheath corticosteroid+lidocaine injection 5min later. During their clinic visit, patients rated their pain prior to intervention and 1min following the intervention, pain of the needle, pain of the medication, procedure-related anxiety and satisfaction using the Michigan Hand Outcomes Questionnaire (MHQ). The patients were contacted 24h post-injection(s) and asked to rate their pain (VAS) and satisfaction (MHQ). Final follow-up was done 3-6months later to determine triggering resolution and complications. A power analysis was done based on the primary outcome of pain improvement and demonstrated a sample size of 20 patients per group to achieve power of 80%.Results:
Fourty-two patients (17 male,25 female), with a mean age of 54.5years were included in the study. All patients reported initial relief of symptoms, with improvement of VAS and MHQ scores post-injection. One patient in the single injection group reported skin discoloration over the injection site. No other complications were noted. When comparing the two groups, pre-injection anesthesia with lidocaine injection resulted in significantly lower needle introduction pain when entering the tendon sheath(p=0.004) and less pain when administering the corticosteroid itself(p=0.019)(Table1). However, there was no significant difference in overall pain improvement between groups at 1min and 24h following the injection(s)(Table2). Additionally, no differences were noted in patient satisfaction between groups(Table2).Conclusion:Our study demonstrates that injecting a local anesthetic to numb the skin prior to injection of intrasheath corticosteroid+lidocaine provided patients with temporary pain relief during needle insertion and intrasheath infiltration. The effect of decreased procedural pain was transient and only lasted for the duration of the procedure itself;there was no significant difference in overall post-procedural pain improvement between the two groups at 1min and 24h post-injection. We do not recommend the routine use of an additional subdermal lidocaine injection in all patients treated for trigger finger, but rather see it as a pain-reducing adjuvant for anxious patients or patients who report trouble with intrasheath injections in the past.
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