Cool! Ice Therapy to Reduce Pain from Laceration Repair

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Applying an ice cube (inside a sterile glove) to the skin over a laceration for 2 minutes significantly reduced pain from local anesthetic injection.

Why does this matter?
Lidocaine hurts!  It ranks right there behind a LP or ABG.  Not naming any names, but some of us are big babies when it comes to needles.  Anything we can do that is safe, cost effective, efficient, and efficacious to reduce pain is a good thing for our patients.  We can't spray ethyl chloride (aka "freezy spray") on an open wound.  But vapocoolant therapy is effective at reducing pain from needle stick.  So maybe cooling a wound prior to injection would work?

Stop...collaborate and listen, Ice is back with my brand new invention...
This was a single center RCT with 25 adult patients in each group.  One had a 1.5cm3 piece of ice inside a sterile glove applied to a laceration for 2 minutes prior to local anesthetic injection.  The other group got no pretreatment.  The median pain score in the ice group was 2; controls scored a 5.  This was clinically and statistically significant.  There were no wound complications in the ice group.  This is a game changer, especially for children.  Note, this study didn't include children - I am extrapolating.  We use topical LET gel, which is usually very effective on the face.  But it is sometimes less effective on the thicker scalp or on the extremities.  This is a new tool in my pain control armamentarium.  How cool! Yeah, I meant that pun...

Source
Pre-emptive ice cube cryotherapy for reducing pain from local anaesthetic injections for simple lacerations: a randomised controlled trial.  Emerg Med J. 2017 Oct 12. pii: emermed-2017-206585. doi: 10.1136/emermed-2017-206585. [Epub ahead of print]

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