{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:57:35Z","timestamp":1787241455322,"version":"build-2736575974"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>A variety of adjuncts for local anaesthesia (LA) exists for dermatological surgery, along with many options to reduce the pain of LA. This review aims to summarize the evidence relating to such adjuncts and methods to reduce the pain of LA. Adjuncts to LA can be an important consideration to optimize anaesthetic effect. Current evidence suggests that buffering and warming of LA fluid, along with cooling, pinching and administering vibrations to the skin are effective at reducing pain during administration. In this review, no significant difference in pain reduction was found between cooling and administering vibrations to the skin. Studies demonstrate that, overall, LA injection into distal sites is safe. However, the evidence specific to dermatological surgery is limited with regard to ways to reduce pain during LA injection and in determining the safety of LA for distal sites with confidence. Further high-quality research in the form of multicentre randomized controlled trials is required.<\/jats:p>","DOI":"10.1111\/ced.15277","type":"journal-article","created":{"date-parts":[[2022,5,28]],"date-time":"2022-05-28T02:44:22Z","timestamp":1653705862000},"page":"1781-1793","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Local anaesthetics in dermatological surgery: a review of adjuncts and pain reduction techniques"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0805-5068","authenticated-orcid":false,"given":"Maria","family":"Charalambides","sequence":"first","affiliation":[{"name":"City Hospital, Sandwell and West Birmingham NHS Trust Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Yannoulias","sequence":"additional","affiliation":[{"name":"New Cross Hospital The Royal Wolverhampton NHS Trust Wolverhampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2087-6264","authenticated-orcid":false,"given":"Dushyanth","family":"Gnanappiragasam","sequence":"additional","affiliation":[{"name":"Leicester Royal Infirmary Leicester University Hospitals NHS Trust Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Veitch","sequence":"additional","affiliation":[{"name":"Leicester Royal Infirmary Leicester University Hospitals NHS Trust Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5920-6888","authenticated-orcid":false,"given":"Aaron","family":"Wernham","sequence":"additional","affiliation":[{"name":"Leicester Royal Infirmary Leicester University Hospitals NHS Trust Leicester UK"},{"name":"Walsall Manor Hospital Walsall Healthcare NHS Trust Walsall UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,10,1]]},"reference":[{"key":"2025081216142607500_ced15277-bib-0001","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1308\/003588412X13171221501267","article-title":"The power of words: sources of anxiety in patients undergoing local anaesthetic plastic surgery","volume":"94","author":"Caddick","year":"2012","journal-title":"Ann R Coll Surg Engl"},{"key":"2025081216142607500_ced15277-bib-0002","doi-asserted-by":"crossref","first-page":"397","DOI":"10.5435\/00124635-200607000-00002","article-title":"Psychosocial factors and surgical outcomes: an evidence-based literature review","volume":"14","author":"Rosenberger","year":"2006","journal-title":"J Am Acad Orthop Surg"},{"key":"2025081216142607500_ced15277-bib-0003","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1097\/DSS.0000000000001385","article-title":"Bupivacaine as an adjunct to lidocaine in Mohs micrographic surgery: a prospective randomized controlled trial","volume":"44","author":"Chen","year":"2018","journal-title":"Dermatologic Surg"},{"key":"2025081216142607500_ced15277-bib-0004","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1177\/229255031302100112","article-title":"Onset and duration of intradermal mixtures of bupivacaine and lidocaine with epinephrine","volume":"21","author":"Collins","year":"2013","journal-title":"Can J Plast Surg"},{"key":"2025081216142607500_ced15277-bib-0005","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1046\/j.1524-4725.1999.99138.x","article-title":"Comparative study of the efficacy of four topical anesthetics","volume":"25","author":"Friedman","year":"1999","journal-title":"Dermatol Surg"},{"key":"2025081216142607500_ced15277-bib-0006","doi-asserted-by":"crossref","first-page":"107","DOI":"10.33160\/yam.2021.02.014","article-title":"Effect of subcutaneous adrenaline\/saline\/lidocaine injection on split-thickness skin graft donor site wound healing","volume":"64","author":"Fukuoka","year":"2021","journal-title":"Yonago Acta Med"},{"key":"2025081216142607500_ced15277-bib-0007","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1111\/j.1524-4725.1994.tb00150.x","article-title":"Comparison of iontophoresis of lidocaine with a eutectic mixture of lidocaine and prilocaine (EMLA) for topically administered local anesthesia","volume":"20","author":"Greenbaum","year":"1994","journal-title":"J Dermatol Surg Oncol"},{"key":"2025081216142607500_ced15277-bib-0008","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/S0190-9622(96)90608-8","article-title":"Eutectic lidocaine\/prilocaine 5% cream and patch may provide satisfactory analgesia for excisional biopsy or curettage with electrosurgery of cutaneous lesions. A randomized, controlled, parallel group study","volume":"35","author":"Gupta","year":"1996","journal-title":"J Am Acad Dermatol"},{"key":"2025081216142607500_ced15277-bib-0009","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jaad.2008.08.001","article-title":"A randomized, double-blind comparison of the total dose of 1.0% lidocaine with 1: 100,000 epinephrine versus 0.5% lidocaine with 1:200,000 epinephrine required for effective local anesthesia during Mohs micrographic surgery for skin cancers","volume":"60","author":"Morganroth","year":"2009","journal-title":"J Am Acad Dermatol"},{"key":"2025081216142607500_ced15277-bib-0010","doi-asserted-by":"crossref","first-page":"65","DOI":"10.4103\/joacp.JOACP_73_18","article-title":"Comparative evaluation of the efficacy of two anesthetic gels (2% lignocaine and 20% benzocaine) in reducing pain during administration of local anesthesia \u2013 a randomized controlled trial","volume":"35","author":"Nair","year":"2019","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2025081216142607500_ced15277-bib-0011","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jaad.2019.09.088","article-title":"Buffered lidocaine 1%\/epinephrine 1:100,000 with sodium bicarbonate (sodium hydrogen carbonate) in a 3:1 ratio is less painful than a 9:1 ratio: a double-blind, randomized, placebo-controlled, crossover trial","volume":"83","author":"Vent","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"2025081216142607500_ced15277-bib-0012","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1524-4725.2011.02146.x","article-title":"Clinical trial for safety evaluation of hyaluronidase as diffusion enhancing adjuvant for infiltration analgesia of skin with lidocaine","volume":"38","author":"Wohlrab","year":"2012","journal-title":"Dermatol Surg"},{"key":"2025081216142607500_ced15277-bib-0013","first-page":"CD010645","article-title":"Adrenaline with lidocaine for digital nerve blocks","volume":"2015","author":"Prabhakar","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2025081216142607500_ced15277-bib-0014","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3233\/CH-2012-1629","article-title":"Skin perfusion and pain evaluation with different local anaesthetics in a double blind randomized study following digital nerve block anaesthesia","volume":"55","author":"Schnabl","year":"2013","journal-title":"Clin Hemorheol Microcirc"},{"key":"2025081216142607500_ced15277-bib-0015","doi-asserted-by":"crossref","first-page":"1654","DOI":"10.1111\/j.1524-4725.2012.02522.x","article-title":"Prospective comparison between buffered 1% lidocaine-epinephrine and skin cooling in reducing the pain of local anesthetic infiltration","volume":"38","author":"Al Shahwan","year":"2012","journal-title":"Dermatol Surg"},{"key":"2025081216142607500_ced15277-bib-0016","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1111\/jocd.13160","article-title":"A prospective comparison between skin cooling and skin vibration in reducing the pain of local anesthetic infiltration","volume":"19","author":"Alshahwan","year":"2020","journal-title":"J Cosmet Dermatol"},{"key":"2025081216142607500_ced15277-bib-0017","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1111\/j.1553-2712.1995.tb03218.x","article-title":"The effects of warming and buffering on pain of infiltration of lidocaine","volume":"2","author":"Bartfield","year":"1995","journal-title":"Acad Emerg Med"},{"key":"2025081216142607500_ced15277-bib-0018","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1111\/j.1524-4725.1998.tb04246.x","article-title":"Slow infusion tumescent anesthesia","volume":"24","author":"Breuninger","year":"1998","journal-title":"Dermatol Surg"},{"key":"2025081216142607500_ced15277-bib-0019","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jaad.2005.06.043","article-title":"Decreasing the pain of local anesthesia: a prospective, double-blind comparison of buffered, premixed 1% lidocaine with epinephrine versus 1% lidocaine freshly mixed with epinephrine","volume":"54","author":"Burns","year":"2006","journal-title":"J Am Acad Dermatol"},{"key":"2025081216142607500_ced15277-bib-0020","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/jocd.13554","article-title":"Use of vibrating anesthetic device reduces the pain of mesotherapy injections: a randomized split-scalp study","volume":"20","author":"Carvalho","year":"2021","journal-title":"J Cosmet Dermatol"},{"key":"2025081216142607500_ced15277-bib-0021","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/S0735-6757(98)90126-7","article-title":"Pain reduction in lidocaine administration through buffering and warming","volume":"16","author":"Colaric","year":"1998","journal-title":"Am J Emerg Med"},{"key":"2025081216142607500_ced15277-bib-0022","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/S1090-3801(99)90187-8","article-title":"Pain and mechanical injury of human skin following needle insertions","volume":"3","author":"Egekvist","year":"1999","journal-title":"Eur J Pain"},{"key":"2025081216142607500_ced15277-bib-0023","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.jaad.2018.08.011","article-title":"Use of a vibrating kinetic anesthesia device reduces the pain of lidocaine injections: a randomized split-body trial","volume":"80","author":"Fix","year":"2019","journal-title":"J Am Acad Dermatol"},{"key":"2025081216142607500_ced15277-bib-0024","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/S0190-9622(98)70404-9","article-title":"Repetitive pinching of the skin during lidocaine infiltration reduces patient discomfort","volume":"39","author":"Fosko","year":"1998","journal-title":"J Am Acad Dermatol"},{"key":"2025081216142607500_ced15277-bib-0025","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/IOP.0000000000001209","article-title":"A systematic review and meta-analysis of methods for reducing local anesthetic injection pain among patients undergoing periocular surgery","volume":"35","author":"Gostimir","year":"2019","journal-title":"Ophthalmic Plast Reconstr Surg"},{"key":"2025081216142607500_ced15277-bib-0026","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1001\/jamafacial.2019.0733","article-title":"Effect of a vibratory anesthetic device on pain anticipation and subsequent pain perception among patients undergoing cutaneous cancer removal surgery: a randomized clinical trial","volume":"21","author":"Govas","year":"2019","journal-title":"JAMA Facial Plast Surg"},{"key":"2025081216142607500_ced15277-bib-0027","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/AAP.0b013e31819a12a6","article-title":"Efficacy of bicarbonate in decreasing pain on intradermal injection of local anesthetics: a meta-analysis","volume":"34","author":"Hanna","year":"2009","journal-title":"Reg Anesth Pain Med"},{"key":"2025081216142607500_ced15277-bib-0028","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.annemergmed.2010.12.001","article-title":"Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain","volume":"58","author":"Hogan","year":"2011","journal-title":"Ann Emerg Med"},{"key":"2025081216142607500_ced15277-bib-0029","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1177\/1203475419867606","article-title":"Nitrous oxide reduces pain associated with local anesthetic injections","volume":"23","author":"Lin","year":"2019","journal-title":"J Cutan Med Surg"},{"key":"2025081216142607500_ced15277-bib-0030","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/S0196-0644(94)70076-1","article-title":"Reducing the pain of local anesthetic infiltration: warming and buffering have a synergistic effect","volume":"23","author":"Mader","year":"1994","journal-title":"Ann Emerg Med"},{"key":"2025081216142607500_ced15277-bib-0031","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1016\/j.jaad.2011.04.011","article-title":"A randomized controlled crossover trial: lidocaine injected at a 90-degree angle causes less pain than lidocaine injected at a 45-degree angle","volume":"65","author":"Martires","year":"2011","journal-title":"J Am Acad Dermatol"},{"key":"2025081216142607500_ced15277-bib-0032","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1054\/bjps.1997.0293","article-title":"Randomised control trial of pH buffered lignocaine with adrenaline in outpatient operations","volume":"51","author":"Masters","year":"1998","journal-title":"Br J Plast Surg"},{"key":"2025081216142607500_ced15277-bib-0033","doi-asserted-by":"crossref","first-page":"275","DOI":"10.4103\/JCAS.JCAS_192_19","article-title":"Tumescent anesthesia for dermatosurgical procedures other than liposuction","volume":"13","author":"Uttamani","year":"2020","journal-title":"J Cutan Aesthet Surg"},{"key":"2025081216142607500_ced15277-bib-0034","first-page":"1119","article-title":"Warm and neutral tumescent anesthetic solutions are essential factors for a less painful injection","volume":"32","author":"Yang","year":"2006","journal-title":"Dermatol Surg"},{"key":"2025081216142607500_ced15277-bib-0035","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s40001-016-0201-5","article-title":"Hyaluronidase: from clinical applications to molecular and cellular mechanisms","volume":"21","author":"Buhren","year":"2016","journal-title":"Eur J Med Res"},{"key":"2025081216142607500_ced15277-bib-0036","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/00006534-199802000-00015","article-title":"The effects of hyaluronidase on the efficacy and on the pain of administration of 1% lidocaine","volume":"101","author":"Nevarre","year":"1998","journal-title":"Plast Reconstr Surg"},{"key":"2025081216142607500_ced15277-bib-0037","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1097\/PRS.0b013e318245ea27","article-title":"Efficacy study of hyaluronidase as a diffusion promoter for lidocaine in infiltration analgesia of skin","volume":"129","author":"Wohlrab","year":"2012","journal-title":"Plast Reconstr Surg"},{"key":"2025081216142607500_ced15277-bib-0038","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s00238-010-0529-y","article-title":"Creeping anaesthesia for nasal surgery\u2014A relatively painless technique","volume":"34","author":"Pandya","year":"2011","journal-title":"Eur J Plast Surg"},{"key":"2025081216142607500_ced15277-bib-0039","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1097\/DSS.0000000000002314","article-title":"Differential analgesia from vibratory stimulation during local injection of anesthetic: a randomized clinical trial","volume":"46","author":"Kazi","year":"2020","journal-title":"Dermatol Surg"},{"key":"2025081216142607500_ced15277-bib-0040","doi-asserted-by":"crossref","first-page":"449","DOI":"10.4103\/0259-1162.194576","article-title":"Anesthesiologist's role in relieving patient's anxiety","volume":"11","author":"Mohan","year":"2017","journal-title":"Anesth Essays Res"}],"container-title":["Clinical and Experimental Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ced.15277","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ced.15277","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/47\/10\/1781\/48530436\/ced1781.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/47\/10\/1781\/48530436\/ced1781.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T20:14:37Z","timestamp":1755029677000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ced\/article\/47\/10\/1781\/6966105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,1]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10,1]]},"published-print":{"date-parts":[[2022,10,1]]}},"URL":"https:\/\/doi.org\/10.1111\/ced.15277","relation":{},"ISSN":["1365-2230","0307-6938"],"issn-type":[{"value":"1365-2230","type":"electronic"},{"value":"0307-6938","type":"print"}],"subject":[],"published-other":{"date-parts":[[2022,10,1]]},"published":{"date-parts":[[2022,10,1]]},"assertion":[{"value":"2022-05-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}