Minor dermatological procedures are routinely performed in outpatient clinical practice. These procedures include skin biopsy, removal of benign lesions, electrocautery, curettage, cryotherapy, and minor excisions[1]. Despite being relatively simple, these procedures may cause pain and anxiety among patients. Effective pain control is therefore essential for patient comfort, procedural success, and overall satisfaction.

Local anesthesia is widely used to achieve adequate analgesia during dermatological procedures. Traditionally, injectable local anesthetics, particularly lidocaine infiltration, have been considered the gold standard due to their rapid onset and reliable analgesia[2]. However, injection itself may cause discomfort and anxiety, particularly among needle-phobic patients.

In contrast, topical anesthetics, such as eutectic mixtures of lidocaine and prilocaine (EMLA), offer a non-invasive alternative that eliminates injection-related pain. These agents act by penetrating the skin and blocking sodium channels in nerve fibers, thereby preventing transmission of pain signals[3]. However, topical anesthetics often have a slower onset of action and may provide less profound anesthesia for deeper procedures.

Previous clinical studies have demonstrated varying results regarding the comparative efficacy of topical and injectable anesthetics. Injectable lidocaine has been shown to provide superior intra-procedural pain control compared with topical anesthetic creams in several studies[4-5]. However, topical anesthesia offers the advantage of painless application and improved patient acceptability.

Given the increasing number of outpatient dermatological procedures and the need to optimize patient comfort, it is important to evaluate the relative effectiveness of these anesthetic techniques[6].

The present study was conducted to compare topical anesthesia and injectable local anesthesia in terms of pain control, onset time, patient satisfaction, and complications during minor dermatological procedures[7].

This was a prospective comparative study conducted in the dermatology outpatient department of Pacific Institute of Medical Sciences, Udaipur, Rajasthan over a period of 06 months. A total of 100 patients undergoing minor dermatological procedures were included in the study. Inclusion Criteria • Patients aged 18–65 years • Patients undergoing minor dermatological procedures such as: o Skin biopsy o Wart removal o Electrocautery o Excision of benign lesions • Patients who provided informed consent Exclusion Criteria • Allergy to local anesthetics • Active infection at procedure site • Pregnancy or lactation • Patients with neurological disorders affecting pain perception • Patients on systemic analgesics or sedatives Sample Size A total of 100 patients were enrolled and randomly divided into two groups of 50 each. • Group A: Topical anesthesia (EMLA cream) • Group B: Injectable anesthesia (2% lidocaine infiltration) Procedure Group A: Topical Anesthesia • EMLA cream (lidocaine 2.5% + prilocaine 2.5%) was applied to the procedure site. • The area was covered with an occlusive dressing. • The cream was left in place for 30 minutes before the procedure. Group B: Injectable Anesthesia • 2% lidocaine solution was injected intradermally around the procedure site using a 26-gauge needle. • Procedure was performed once adequate anesthesia was achieved. Outcome Measures Primary Outcome • Pain during the procedure assessed using Visual Analog Scale (VAS) (0–10) Secondary Outcomes • Pain during administration of anesthesia • Onset time of anesthesia • Duration of anesthesia • Patient satisfaction • Complications (erythema, edema, infection) Statistical Analysis Data were analyzed using SPSS version 25. Statistical tests used: • Student’s t-test for continuous variables • Chi-square test for categorical variables A p-value < 0.05 was considered statistically significant.

Table 1: Demographic Characteristics of Patients

No statistically significant difference was observed between the two groups in terms of demographic characteristics.

Table 2: Comparison of Pain Scores

Pain during anesthesia administration was significantly higher in the injectable group, whereas procedural pain was significantly lower.

Table 3: Onset and Duration of Anesthesia

Injectable anesthesia demonstrated significantly faster onset and longer duration.

Table 4: Patient Satisfaction and Complications

Patient satisfaction was significantly higher in the injectable group.

An essential part of dermatological procedures is effective pain control. In order to guarantee patient comfort, lower anxiety, and promote optimal operative outcomes, local anesthetic is crucial [8].

In this study, 100 patients had minor dermatological treatments, and topical anesthetic and injection local anesthesia were compared.

Pain Control

According to our research, injectable anesthesia outperformed topical anesthetic in terms of intra-procedural pain management [9]. The injectable group had a considerably lower mean VAS score during the procedure.

These results are in line with other research showing that lidocaine infiltration produces more potent analgesia than topical anesthetic creams.

Injectable anesthetics significantly reduced pain levels when compared to topical anesthetics (p < 0.001) in a prospective study of 100 individuals with keloids.

Because injectable anesthetic can reach deeper dermal nerve endings, it may have a better analgesic impact [10].

Pain during Administration

Although injectable anesthesia provides superior procedural analgesia, it is associated with pain during administration. In our study, patients reported significantly higher pain scores during injection compared with topical cream application[11].

Injection pain may result from tissue distension and the acidic pH of lidocaine solutions. Buffering lidocaine with sodium bicarbonate has been shown to reduce injection discomfort.

Onset Time

Topical anesthetics require approximately 20–30 minutes to achieve adequate anesthesia, whereas injectable lidocaine acts within a few minutes. Our results confirmed a significantly shorter onset time with injectable anesthesia[12].

Delayed onset is one of the main limitations of topical anesthetics and may prolong procedure preparation time.

Patient Satisfaction

Despite injection discomfort, overall patient satisfaction was higher in the injectable anesthesia group. This may be due to the more reliable pain control during the procedure.

Complications

In general, both anesthetic techniques were safe. Both groups experienced mild side effects as edema and erythema, but they were not statistically significant [13–14]. Although they are uncommon, topical anesthetics can occasionally result in methemoglobinemia or allergic responses.

Clinical Implications

The findings suggest that injectable anesthesia remains the preferred technique for most dermatological procedures requiring deeper tissue manipulation.

However, topical anesthesia may be particularly useful in:

• Superficial procedures
• Pediatric patients
• Needle-phobic individuals
• Cosmetic dermatology procedures

Combining topical and injectable anesthesia may also improve patient comfort.

Limitations

The study had limitations:

• Single-center study
• Relatively small sample size
• Limited variety of dermatological procedures

Further multicenter randomized controlled trials are required to validate these findings.

The present study demonstrates that injectable local anesthesia provides significantly better intra-procedural analgesia and faster onset compared with topical anesthesia in minor dermatological procedures. However, topical anesthesia offers the advantage of painless application and may be beneficial for superficial procedures or patients with needle phobia. Injectable anesthesia remains the gold standard for most dermatological procedures requiring effective and reliable pain control.

An essential part of dermatological procedures is effective pain control. In order to guarantee patient comfort, lower anxiety, and promote optimal operative outcomes, local anesthetic is crucial [8].

In this study, 100 patients had minor dermatological treatments, and topical anesthetic and injection local anesthesia were compared.

Pain Control

According to our research, injectable anesthesia outperformed topical anesthetic in terms of intra-procedural pain management [9]. The injectable group had a considerably lower mean VAS score during the procedure.

These results are in line with other research showing that lidocaine infiltration produces more potent analgesia than topical anesthetic creams.

Injectable anesthetics significantly reduced pain levels when compared to topical anesthetics (p < 0.001) in a prospective study of 100 individuals with keloids.

Because injectable anesthetic can reach deeper dermal nerve endings, it may have a better analgesic impact [10].

Pain during Administration

Although injectable anesthesia provides superior procedural analgesia, it is associated with pain during administration. In our study, patients reported significantly higher pain scores during injection compared with topical cream application[11].

Injection pain may result from tissue distension and the acidic pH of lidocaine solutions. Buffering lidocaine with sodium bicarbonate has been shown to reduce injection discomfort.

Onset Time

Topical anesthetics require approximately 20–30 minutes to achieve adequate anesthesia, whereas injectable lidocaine acts within a few minutes. Our results confirmed a significantly shorter onset time with injectable anesthesia[12].

Delayed onset is one of the main limitations of topical anesthetics and may prolong procedure preparation time.

Patient Satisfaction

Despite injection discomfort, overall patient satisfaction was higher in the injectable anesthesia group. This may be due to the more reliable pain control during the procedure.

Complications

In general, both anesthetic techniques were safe. Both groups experienced mild side effects as edema and erythema, but they were not statistically significant [13–14]. Although they are uncommon, topical anesthetics can occasionally result in methemoglobinemia or allergic responses.

Clinical Implications

The findings suggest that injectable anesthesia remains the preferred technique for most dermatological procedures requiring deeper tissue manipulation.

However, topical anesthesia may be particularly useful in:

• Superficial procedures
• Pediatric patients
• Needle-phobic individuals
• Cosmetic dermatology procedures

Combining topical and injectable anesthesia may also improve patient comfort.

Limitations

The study had limitations:

• Single-center study
• Relatively small sample size
• Limited variety of dermatological procedures

Further multicenter randomized controlled trials are required to validate these findings.

The present study demonstrates that injectable local anesthesia provides significantly better intra-procedural analgesia and faster onset compared with topical anesthesia in minor dermatological procedures. However, topical anesthesia offers the advantage of painless application and may be beneficial for superficial procedures or patients with needle phobia. Injectable anesthesia remains the gold standard for most dermatological procedures requiring effective and reliable pain control.

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