Will Clay
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Introduction
Patients attending for local anaesthetic day-case procedures to excise skin lesions often report their greatest concern is the local anaesthetic. We set out to investigate the differences between predicted and reported pain scores of having local anaesthetic infiltrated.
Methods
All plastic surgery patients undergoing excision of skin lesions across a three-week period in one centre were offered a questionnaire post-operatively. 44 patients recorded predicted and reported pain scores on an unhatched 100mm Visual Analogue Scale, scoring pain of injection, pain intraoperatively and expected pain in 24 hours. Operation notes were inspected for details on injection site, anaesthetic choice and any adjunctive measures. 12 patients were excluded due to errors in their questionnaires.
Results
We found a positive correlation between predicted and reported pain scores (Pearson r = 0.592, p<0.001). Median predicted pain score was 37.0 (IQR 40.3), median reported pain score was 18.0 (IQR 37.5). There was a statistically significant difference between individuals’ predicted and reported pain scores (paired student t-test = 2.17, p<0.05). There were no differences between different local anaesthetics. There was no correlation between predicted or reported scores and expected pain at 24 hours.
Conclusions
Patients having skin lesion excisions under local anaesthetic are predicting infiltration will be more painful than it is. Some are predicting and reporting pain scores up to 90/100, suggesting significant anxiety around this element of day-case surgery. Further research should investigate the benefits of reassurance, distraction, anaesthetic adjuncts and nerve blocks to help alleviate anxiety and reduce pain on infiltration.
Authors
Will Clay, John Kiely
Mid Yorkshire Teaching NHS Trust, Wakefield, United Kingdom