CC BY 4.0 · The Arab Journal of Interventional Radiology 2024; 08(01): 036-042
DOI: 10.1055/s-0044-1781452
Original Article

Minimizing the Pain of Local Anesthesia Administration in Interventional Radiology with an Anesthetic Portal Technique

Dylan Suttle
1   Greensboro Radiology, Vascular and Interventional Radiology Specialists, Greensboro, North Carolina, United States
Virpal Gill
2   School of Medicine, University of Virginia, Charlottesville, Virginia, United States
Daniel Sheeran
3   Division of Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, Virginia, United States
Nicole Keefe
4   Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, United States
Claire Davis
5   Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, United States
James Patrie
6   Department of Public Health Science, School of Medicine, University of Virginia, Charlottesville, Virginia, United States
John F. Angle
3   Division of Interventional Radiology, Department of Radiology, University of Virginia, Charlottesville, Virginia, United States
› Author Affiliations


Objective This article assesses the effectiveness of a standardized local anesthetic (LA) technique designed to minimize the pain of local anesthesia administration in interventional radiology (IR).

Materials and Methods A prospective study compared participants' experience in a control group (n = 63) of random LA administration techniques to a separate experimental group (n = 60) with a standardized technique based on known methods to minimize the pain of LA. Participants in each group were surveyed after LA administration to assess perceived pain and number of times a painful stick was felt. Participants were also asked to compare LA pain to prior experiences with LA, and to compare the overall pain experienced during the procedure to expected pain.

Statistical Analysis Ordinal variable distribution analyses were performed using the Wilcoxon rank sum test. Categorical variable analyses were performed with the Pearson's global exact chi-square test.

Results Pain of LA (mean 1.1 vs. 3.3 on a 0–10 scale, p < 0.001), number of times a painful stick was felt (mean 0.8 vs. 1.9 times, p < 0.001), and overall pain during the procedure (mean 1.5 vs. 3.4 on 0–10 scale, p < 0.001) were significantly less using the standardized versus random techniques. Compared with prior experiences of LA, pain using the standardized technique was less in 77.6%, the same in 22.4%, and more in 0% of patients while pain using the random technique was less in 46.4%, the same in 39.3%, and more in 14.3% of patients (p < 0.05).

Conclusion Severity and frequency of pain from LA administration in IR procedures is minimized using a standardized anesthetic portal technique. This technique may also decrease overall pain experienced during IR procedures as well.

Ethical Approval Statement

The University of Virginia Institutional Review Board reviewed this study and approved it as a quality improvement study.

Authors' Contribution

The first author, D.S., led this study and authorship of the paper with each of the remaining authors contributing equally to the study design, data collection, data analysis, and/or manuscript edits and reviews.

Publication History

Article published online:
29 February 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Strazar AR, Leynes PG, Lalonde DH. Minimizing the pain of local anesthesia injection. Plast Reconstr Surg 2013; 132 (03) 675-684
  • 2 Lalonde D, Bell M, Benoit P, Sparkes G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am 2005; 30 (05) 1061-1067
  • 3 Culp Jr WC, Culp WC. Practical application of local anesthetics. J Vasc Interv Radiol 2011; 22 (02) 111-118 , quiz 119
  • 4 Skin. In: Mescher AL. ed. Junqueira's Basic Histology, 14e. New York, NY: McGrawHill; Accessed May 8, 2018 at:
  • 5 Egekvist H, Bjerring P, Arendt-Nielsen L. Pain and mechanical injury of human skin following needle insertions. Eur J Pain 1999; 3 (01) 41-49
  • 6 Steele EA, Ng JD, Poissant TM, Campbell NM. Comparison of injection pain of articaine and lidocaine in eyelid surgery. Ophthal Plast Reconstr Surg 2009; 25 (01) 13-15
  • 7 Mustoe TA, Buck II DW, Lalonde DH. The safe management of anesthesia, sedation, and pain in plastic surgery. Plast Reconstr Surg 2010; 126 (04) 165e-176e
  • 8 Martires KJ, Malbasa CL, Bordeaux JS. A randomized controlled crossover trial: lidocaine injected at a 90-degree angle causes less pain than lidocaine injected at a 45-degree angle. J Am Acad Dermatol 2011; 65 (06) 1231-1233
  • 9 Hanna MN, Elhassan A, Veloso PM. et al. Efficacy of bicarbonate in decreasing pain on intradermal injection of local anesthetics: a meta-analysis. Reg Anesth Pain Med 2009; 34 (02) 122-125
  • 10 Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: rate of administration and buffering. Ann Emerg Med 1998; 31 (01) 36-40
  • 11 Thomson CJ, Lalonde DH, Denkler KA, Feicht AJ. A critical look at the evidence for and against elective epinephrine use in the finger. Plast Reconstr Surg 2007; 119 (01) 260-266
  • 12 Thomson CJ, Lalonde DH. Randomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block. Plast Reconstr Surg 2006; 118 (02) 429-432
  • 13 Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with high-dose (1:1,000) epinephrine: does it cause finger necrosis and should it be treated?. Hand (N Y) 2007; 2 (01) 5-11
  • 14 Mohan PP. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. Epinephrine in digital nerve block. Emerg Med J 2007; 24 (11) 789-790
  • 15 Denkler K. Dupuytren's fasciectomies in 60 consecutive digits using lidocaine with epinephrine and no tourniquet. Plast Reconstr Surg 2005; 115 (03) 802-810
  • 16 Moran TC, Kaye AD, Mai AH, Bok LR. Sedation, analgesia, and local anesthesia: a review for general and interventional radiologists. Radiographics 2013; 33 (02) E47-E60
  • 17 Cepeda MS, Tzortzopoulou A, Thackrey M, Hudcova J, Arora Gandhi P, Schumann R. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev 2010; (12) CD006581
  • 18 Colaric KB, Overton DT, Moore K. Pain reduction in lidocaine administration through buffering and warming. Am J Emerg Med 1998; 16 (04) 353-356
  • 19 Hogan ME, vanderVaart S, Perampaladas K, Machado M, Einarson TR, Taddio A. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med 2011; 58 (01) 86-98.e1
  • 20 Zilinsky I, Bar-Meir E, Zaslansky R, Mendes D, Winkler E, Orenstein A. Ten commandments for minimal pain during administration of local anesthetics. J Drugs Dermatol 2005; 4 (02) 212-216
  • 21 Dickenson AH. Gate control theory of pain stands the test of time. Br J Anaesth 2002; 88 (06) 755-757
  • 22 Pascuet E, Donnelly RF, Garceau D, Vaillancourt R. Buffered lidocaine hydrochloride solution with and without epinephrine: stability in polypropylene syringes. Can J Hosp Pharm 2009; 62 (05) 375-380
  • 23 Burns CA, Ferris G, Feng C, Cooper JZ, Brown MD. 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. J Am Acad Dermatol 2006; 54 (01) 128-131
  • 24 Xia Y, Chen E, Tibbits DL, Reilley TE, McSweeney TD. Comparison of effects of lidocaine hydrochloride, buffered lidocaine, diphenhydramine, and normal saline after intradermal injection. J Clin Anesth 2002; 14 (05) 339-343