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Minimally Painful Local Anesthetic Injection for Cleft Lip/Nasal Repair in Grown Patients

Lalonde, Donald H. MD*; Price, Christopher MD; Wong, Alison L. MD*; Chokotho, Tilinde MD

Plastic and Reconstructive Surgery – Global Open: June 2014 - Volume 2 - Issue 6 - p e171
doi: 10.1097/GOX.0000000000000077
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Introduction: There has been a recent interest in injecting large body and face areas with local anesthetic in a minimally painful manner. The method includes adherence to minimal pain injection details as well feedback from the patient who counts the number of times he feels pain during the injection process. This article describes the successes and limitations of this technique as applied to primary cleft lip/nasal repair in grown patients.

Methods: Thirty-two primary cleft lip patients were injected with local anesthesia by 3 surgeons and then underwent surgical correction of their deformity. At the beginning of the injection of the local anesthetic, patients were instructed to clearly inform the injector each and every time they felt pain during the entire injection process.

Results: The average patient felt pain only 1.6 times during the injection process. This included the first sting of the first 27-gauge needle poke. The only pain that 51% of the patients felt was that first poke of the first needle; 24% of the patients only felt pain twice during the whole injection process. The worst pain score occurred in a patient who felt pain 6 times during the injection process. Ninety-one percent of the patients felt no pain at all after the injection of the local anesthetic and did not require a top-up.

Conclusion: It is possible to successfully and reliably inject local anesthesia in a minimally painful manner for cleft lip and nasal repair in the fully grown cleft patient.

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From the *Division of Plastic Surgery, Dalhousie University, Saint John, New Brunswick, Canada; Division of Plastic Surgery, University of Cape Town, South Africa; Queen Elizabeth Central Hospital, Blantyre, Malawi.

Received for publication December 3, 2013; accepted February 4,2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the authors.

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Donald H. Lalonde, MD, Division of Plastic Surgery, Dalhousie University, Hilyard Place, Suite C204, 600 Main Street, Saint John, New Brunswick E2K 1J5, Canada, E-mail:;

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© 2014 American Society of Plastic Surgeons