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Benefit of Local Anesthesia in Reducing Pain during Collagenase Injection for Dupuytren's Contracture

Nordenskjöld, Jesper LU ; Waldén, Markus; Kjellin, Anders LU ; Franzén, Herbert and Atroshi, Isam LU (2017) In Plastic and Reconstructive Surgery 140(3). p.565-569
Abstract

Collagenase injection for Dupuytren's contracture is commonly administered without anesthesia. The authors studied the benefit of injecting local anesthesia before collagenase in reducing treatment-related pain. This prospective cohort study included 187 patients (mean age, 69 years; 80 percent men) at two orthopedic departments in Sweden. At one center, 161 consecutive patients scheduled for collagenase injection were assigned to two groups by alternating outpatient clinics; 78 received collagenase without local anesthesia using a modified method (injecting 0.80 mg in multiple spots in the cord) and 83 received local anesthesia injected in the proximal palm before collagenase. At the other center, 26 consecutive patients received... (More)

Collagenase injection for Dupuytren's contracture is commonly administered without anesthesia. The authors studied the benefit of injecting local anesthesia before collagenase in reducing treatment-related pain. This prospective cohort study included 187 patients (mean age, 69 years; 80 percent men) at two orthopedic departments in Sweden. At one center, 161 consecutive patients scheduled for collagenase injection were assigned to two groups by alternating outpatient clinics; 78 received collagenase without local anesthesia using a modified method (injecting 0.80 mg in multiple spots in the cord) and 83 received local anesthesia injected in the proximal palm before collagenase. At the other center, 26 consecutive patients received collagenase using the standard method (0.58 mg injected in one spot) without local anesthesia. Immediately after the first injection (collagenase or local anesthesia), the patients rated the severity of injection-related pain on a visual analogue scale from 0 (no pain) to 10 (worst pain). Before finger manipulation 1 or 2 days after injection, the patients rated the pain experienced since injection. Mean score ± SD for pain experienced during modified collagenase injection was 4.3 ± 2.5 without local anesthesia and 2.3 ± 1.7 during injection of local anesthesia (before collagenase) (age- and sex-adjusted mean difference, 2.1; 95 percent CI, 1.5 to 2.7; p < 0.001). Mean pain score ± SD during standard collagenase injection without local anesthesia was 4.8 ± 1.8. Mean pain score ± SD during the injection-manipulation interval was 2.9 ± 1.9 in the group without local anesthesia and 2.9 ± 2.3 in the local anesthesia group (p = 0.79). This study shows that local anesthesia significantly reduces the patient's overall pain experience during collagenase treatment for Dupuytren's contracture.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Plastic and Reconstructive Surgery
volume
140
issue
3
pages
5 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85030616954
  • wos:000408590000057
ISSN
0032-1052
DOI
10.1097/PRS.0000000000003583
language
English
LU publication?
yes
id
76287fa9-debd-4765-88a2-a7b1ce8bb79c
date added to LUP
2017-11-03 08:10:57
date last changed
2018-01-16 13:25:37
@article{76287fa9-debd-4765-88a2-a7b1ce8bb79c,
  abstract     = {<p>Collagenase injection for Dupuytren's contracture is commonly administered without anesthesia. The authors studied the benefit of injecting local anesthesia before collagenase in reducing treatment-related pain. This prospective cohort study included 187 patients (mean age, 69 years; 80 percent men) at two orthopedic departments in Sweden. At one center, 161 consecutive patients scheduled for collagenase injection were assigned to two groups by alternating outpatient clinics; 78 received collagenase without local anesthesia using a modified method (injecting 0.80 mg in multiple spots in the cord) and 83 received local anesthesia injected in the proximal palm before collagenase. At the other center, 26 consecutive patients received collagenase using the standard method (0.58 mg injected in one spot) without local anesthesia. Immediately after the first injection (collagenase or local anesthesia), the patients rated the severity of injection-related pain on a visual analogue scale from 0 (no pain) to 10 (worst pain). Before finger manipulation 1 or 2 days after injection, the patients rated the pain experienced since injection. Mean score ± SD for pain experienced during modified collagenase injection was 4.3 ± 2.5 without local anesthesia and 2.3 ± 1.7 during injection of local anesthesia (before collagenase) (age- and sex-adjusted mean difference, 2.1; 95 percent CI, 1.5 to 2.7; p &lt; 0.001). Mean pain score ± SD during standard collagenase injection without local anesthesia was 4.8 ± 1.8. Mean pain score ± SD during the injection-manipulation interval was 2.9 ± 1.9 in the group without local anesthesia and 2.9 ± 2.3 in the local anesthesia group (p = 0.79). This study shows that local anesthesia significantly reduces the patient's overall pain experience during collagenase treatment for Dupuytren's contracture.</p><p>CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.</p>},
  author       = {Nordenskjöld, Jesper and Waldén, Markus and Kjellin, Anders and Franzén, Herbert and Atroshi, Isam},
  issn         = {0032-1052},
  language     = {eng},
  month        = {09},
  number       = {3},
  pages        = {565--569},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Plastic and Reconstructive Surgery},
  title        = {Benefit of Local Anesthesia in Reducing Pain during Collagenase Injection for Dupuytren's Contracture},
  url          = {http://dx.doi.org/10.1097/PRS.0000000000003583},
  volume       = {140},
  year         = {2017},
}