Efficacy of 10% lidocaine gel for injection site pain associated with treprostinil in the treatment of pulmonary hypertension: a report of four cases

Treprostinil, a prostacyclin analogue, is an effective treatment for pulmonary arterial hypertension (PAH). However, continuous subcutaneous infusion is often complicated by severe injection site pain, which can limit continuation of therapy. We report four PAH patients who developed severe injection site pain during subcutaneous treprostinil therapy in the lower abdomen. A hospital-compounded 10% lidocaine gel was applied around the infusion site. Pain was markedly reduced in all cases, with visual analog scale scores improving from 75 to 100/100 to 0–20/100. In two patients, tramadol could be reduced or discontinued, and all patients were able to continue treprostinil therapy without pain-related limitation or treatment interruption. No systemic adverse effects were observed, although one patient experienced mild local skin irritation. Topical 10% lidocaine gel provided rapid and effective relief of injection site pain associated with subcutaneous treprostinil, facilitating continuation of therapy without pain-related interruption in patients with PAH.