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Pre-emptive ice cube cryotherapy for reducing pain from local anaesthetic injections for simple lacerations: a randomised controlled trial
  1. JaeWoo Song1,
  2. HyukHoon Kim1,
  3. EunJung Park1,
  4. Jung Hwan Ahn1,
  5. Eunhui Yoon2,
  6. Samsun Lampotang2,
  7. Nikolaus Gravenstein2,
  8. SangChun Choi1,2
  1. 1 Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
  2. 2 Department of Anaesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
  1. Correspondence to Dr SangChun Choi, Department of Emergency Medicine, Ajou University School of Medicine, Suwon 16499, Republic of Korea; avenue59{at}


Objective Subcutaneous local anaesthetic injection can be painful to patients in the ED. We evaluated the effect of cryotherapy by application of an ice cube to the injection site prior to injection in patients with simple lacerations.

Methods We conducted a prospective, randomised, controlled trial in consented patients with simple lacerations needing primary repair at a single emergency centre from April to July 2016. We randomly assigned patients undergoing repair for simple lacerations to either the cryotherapy group or the control group (standard care; no cryotherapy or other pretreatment of the injection site). In cryotherapy group subjects, we applied an ice cube (size: 1.5×1.5×1.5 cm) placed inside a sterile glove on the wound at the anticipated subcutaneous lidocaine injection site for 2 min prior to injection. The primary outcome was a subjective numeric rating (0–10 scale) of the perceived pain from the subcutaneous local anaesthetic injections. Secondary outcomes were (a) perceived pain on a numeric scale for cryotherapy itself, that is, pain from contact of the ice cube/glove with the skin and (b) the rate of complications after primary laceration repair.

Results Fifty patients were enrolled, consented and randomised, with 25 in the cryotherapy group and 25 in the control group. The numeric rating scale for subcutaneous anaesthetic injections was median, IQR, 95% CI 2.0 (1 to 3.5), 1.81 to 3.47, respectively, in the cryotherapy group and 5.0 (3 to 7), 3.91 to 6.05 in the control group (Mann-Whitney U=147.50, p=0.001). No wound complications occurred in either group. The numeric rating scale for cryotherapy itself was median, IQR, 95% CI: 2.0 (1 to 3.5), 1.90 to 3.70.

Conclusion Pre-emptive topical injection site cryotherapy lasting 2 min before subcutaneous local anaesthetic injections can significantly reduce perceived pain from subcutaneous local anaesthetic injections in patients presenting for simple laceration repair.

Trial registration number KCT0001990.

  • wounds, treatment
  • pain management
  • emergency department

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  • Contributors Research conception and design, literature search: JS and SC. Conduct the trial: HK, JA, EP and JS. Data acquisition: JL and EP. Data analysis and interpretation: EY and SC. Statistical analysis: EY, SL, JA and SC. Drafting of the manuscript: JS, HK and SC. Critical revision of the manuscript: SL, NG and SC. Approval of final manuscript: all authors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Our institutional review board approved the study protocol (AJIRB-MED-BDR-16-020).

  • Provenance and peer review Not commissioned; externally peer reviewed.