A Clinical Comparison of EMLA Cream and Ethyl Chloride Spray Application for Pain Relief of Forehead Botulinum Toxin Injection

Objectives This study aims to analyze the efficiency of EMLA cream and ethyl chloride spray application for pain alleviation before botulinum toxin injection. Methods Forty-five patients were divided into 3 treatment groups. Skin cooling with ethyl chloride spray (in group 1), topical anesthetic cream (EMLA) (in group 2), was used on the forehead area on one side previous to injection; the opposite side served as the control. In the third group (n = 15), cold was applied using ethyl chloride spray to one side, and to the other side topical anesthetic cream (EMLA) was applied. A visual analog scale was used for pain intensity. Results In the first group, the average pain score was 3.20 1.20 on the side where ethyl chloride spray was applied and 7.26 +/- 1.94 on the control side (P < 0.05). It was 4.20 +/- 1.37 on the side receiving EMLA and 7.66 +/- 1.54 (P < 0.05) on the control side in the second group. In the third group, the average score was 6.80 +/- 1.37 for the EMLA side and 2.93 +/- 1.03 for the ethyl chloride sprayed side (P < 0.05). Conclusions Skin cooling with ethyl chloride spray significantly decreases the pain associated during forehead botulinum toxin injections.