Botulinum toxin injection pain relief using a topical anesthetic skin refrigerant

Background: This study was performed to determine if pretreatment application of a topical anesthetic skin refrigerant reduced discomfort during botulinum toxin injection. Methods: Twenty patients were assigned to four groups determined by side of the face pretreated with skin refrigerant and side receiving the first injection. On a Visual Analog Scale of 0-10 patients rated discomfort levels after injections in the glabellar complex with and without pretreatment. Results: Mean discomfort rating for the pretreated side was 3.1, while the mean discomfort rating for the non-pretreated side was 4.5. Discomfort was not affected by the side sprayed (p=0.33) nor by administering the injection to the sprayed side first (p=0.37). The paired t-test revealed a significant difference between discomfort levels on the pretreated and non-pretreated sides (p=0.038) yielding a 95% confidence interval of (-2.71, -0.09). Conclusions: Topical anesthetic skin refrigerant significantly reduces discomfort in a cost-effective manner for reported by patients undergoing botulinum injections. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.