Nadir U, Scaburi IR, Cerci FB, Jeha GM, Tolkachjov SN, et al.
Anais brasileiros de dermatologia. Date of publication 2026 May 1;volume 101(3):501366.
1. An Bras Dermatol. 2026 May-Jun;101(3):501366. doi: 10.1016/j.abd.2026.501366.
Epub 2026 May 9.
How to minimize pain with local anesthesia and improve patient experiences: a
review.
Nadir U(1), Scaburi IR(2), Cerci FB(3), Jeha GM(4), Tolkachjov SN(5).
Author information:
(1)Epiphany Dermatology, Dallas, TX, United States; Department of Dermatology,
Texas A&M School of Medicine, Dallas, TX, United States; Division of
Dermatology, Baylor University Medical Center, Dallas, TX, United States.
(2)Division of Dermatology, Hospital Universitário Evangélico Mackenzie,
Curitiba, PR, Brazil.
(3)Division of Dermatology, Hospital Universitário Evangélico Mackenzie,
Curitiba, PR, Brazil; Clínica Cepelle, Curitiba, PR, Brazil.
(4)Epiphany Dermatology, Dallas, TX, United States; Division of Dermatology,
Baylor University Medical Center, Dallas, TX, United States.
(5)Epiphany Dermatology, Dallas, TX, United States; Department of Dermatology,
Texas A&M School of Medicine, Dallas, TX, United States; Division of
Dermatology, Baylor University Medical Center, Dallas, TX, United States;
Department of Dermatology, University of Texas at Southwestern, Dallas, TX,
United States. Electronic address: Stan.tolkachjov@gmail.com.
BACKGROUND: Local anesthesia is essential in common procedures in dermatology,
but injection and infiltration of anesthetic often cause significant pain,
reducing patient comfort and satisfaction.
OBJECTIVE: To review evidence-based techniques to reduce pain associated with
local anesthetic injection and infiltration.
METHODS AND MATERIALS: A narrative review of the literature was performed, and
techniques were summarized for clinicians to reference.
RESULTS: Technical methods to reduce pain include using smaller-gauge needles
(30-33G), smaller syringes (1‒3 mL), buffering lidocaine with sodium
bicarbonate, inserting the needle at 90 degrees, slow infusion, subcutaneous
delivery, and pore-guided injection. Adjuncts such as warming anesthetic,
vibration, ice, music, and verbal distraction ("talkesthesia") also reduce
patient perception of pain.
STUDY LIMITATIONS: Limitations include heterogeneity in study designs, outcomes
measures, and clinical contexts across the included literature, precluding
quantitative synthesis or direct comparison of individual techniques.
Additionally, several recommendations are based on expert opinion or limited
evidence.
CONCLUSION: A multimodal approach using both technical refinements and
adjunctive measures can make local anesthetic administration less painful.
Dermatologists may routinely implement these strategies to improve patient
experience and satisfaction.
Copyright © 2026 Sociedade Brasileira de Dermatologia. Published by Elsevier
España, S.L.U. All rights reserved.
DOI: 10.1016/j.abd.2026.501366
PMCID: PMC13187960
PMID: 42107926 [Indexed for MEDLINE]
