How to minimize pain with local anesthesia and improve patient experiences: a review

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.