Ethyl Chloride Spray Research Articles

Topical Anesthesia in Cutaneous Head and Neck Surgery: A Randomized Controlled Trial.

Cutaneous head and neck surgery can safely and effectively be performed using local anesthetic (LA). However, optimizing pain management during LA administration is paramount for patient comfort and procedural efficacy. The primary objective of this study was to investigate the comparative effectiveness of EMLA cream and ethyl chloride (EC) spray in mitigating pain associated with LA administration in cutaneous head and neck surgery. Randomized controlled trial. University-affiliated tertiary head and neck oncology center. Sample size calculation was performed followed by computer randomization into the following groups: EMLA, EMLA placebo (aqueous cream), EC, and a control group (no topical agent). Demographics, pain, and procedural experience scores were recorded perioperatively. Statistical analysis was performed to analyse differences between groups utilizing the Mann-Whitney U test, Kruskall-Wallis test, Chi-square test, and Spearman's Rho. 121 cutaneous lesions with a median patient age of 76 were analyzed. There were no statistically significant differences in pain scores (median [IQR]) between patients receiving EMLA (4 [3.75]), EMLA placebo (4.8 [3.6]), EC (5.8 [2.8]), and no treatment (5 [4.1], P = .19). Procedural experience scores were clinically similar (P = .02). Risk factors associated with elevated nociceptive sensitivity were surgical site (scalp, P = .01), malignant lesions (P < .01) and lesion surface area (rs = 0.22, P = .01). EMLA and EC did not mitigate LA-associated pain in patients undergoing cutaneous head and neck surgery and as such practitioners should reconsider their use of these in this regard. Patients' operative experience remains excellent regardless of topical anesthetic use. Ib.

Evaluation of pain-alleviating strategies during allergy shots (subcutaneous immunotherapy): a randomized controlled pilot study.

Background. Subcutaneous immunotherapy (SCIT) is a potential disease-modifying therapy effective for treatment of various allergic disorders. Pain and fear are common concerns of children, which can pose stress and result in negative experiences. The purpose of this study was to evaluate and compare the effectiveness of three marketed distraction devices and ethyl chloride spray (a routinely used topical anesthetic agent for painful procedures), the current clinical standard of care in reducing the perception of needle pain during SCIT administration in children. Methods. 40 children, aged 4-17 years, receiving SCIT with use of one of three alternative pain therapies or with standard practice were enrolled. Participants were randomly assigned to one of the pain-modifying interventions. The three interventional groups were ShotBlocker® (Bionix, Toledo, OH, USA), Buzzy® I (Pain Care Labs, Atlanta, GA, USA) (vibration only), and Buzzy® II (vibration with ice). Control group was ethyl chloride spray. The study consisted of two visits during SCIT administration process. Results. Of these 40 children, 12 received the ShotBlocker, 8 received the Buzzy I, 11 received the Buzzy II, and 9 received ethyl chloride spray (control group). Conclusions. There were no significant differences found between each of the distraction devices and between the control group. Type II error/false negative finding cannot be ruled out because of a small sample. Therefore, we cannot conclude that no true difference exists between each distraction device and the control group simply because of occurrence of a non-significant P-value in our study.

Use of Coolsticks in district general hospital

Introduction: Ethyl chloride spray is conventionally used for testing cold sensation during spinal or epidural blocks.Coolsticks are reusable, durable, non-toxic stainless steels wants that can be cooled and are a cheaper alternative to ethyl chloride spray. The aim of this studd was to estimate the cost and carbon savings of switching from ethyl chloride spray to Coolstick use. Methods: The use of Coolsticks at a single district general hospital’s (Good Hope Hospital, Sutton Coldfield, UK) main theatres was audited in July 2023. The volume of ethyl chloride use in the obstetric theatre in 2022-23 was calculated based on pharmacy requisition forms. Estimates of CO2 equivalent emissions per stick and per ethyl chloride spray use were based on published data (Green Ward study from Dorset). Cost and CO2 equivalent emissions savings with cold sticks were calculated and extrapolated onto all seven theatres within Good Hope Hospital. Results: Only 25% of anaesthetists used Coolsticks, despite all being aware of their availability. The main reason stated for this was “adherence to usual practice”. In the obstetric theatre in 2022-23, 104 cans of ethyl chloride were used. Switching to Coolstick use would save £2,080 and 1,693kg CO2 equivalent per theatre per year. Extrapolating across the hospital, the potential saving was £14,560 and 11,852 kg CO2 equivalent per year. Conclusion: Use of Coolsticks is cost-saving and carbon-efficient. National associations should consider publishing formal recommendations to support their uptake. Research around clinical efficacy and patient satisfaction would speed uptake into clinical practice.

Does the Use of Ethyl Chloride Spray Facilitate Radial Angiography?

Ethyl chloride (EC) spray is a vapocoolant which is used in interventional procedures as a topical local anesthetic. The aim of the present study was to investigate whether or not EC spray can facilitate radial coronary angiography. The study was conducted on a study group EC of 106 (age: 58.1 ± 12.4) patients and a control group (placebo) of 104 (age: 59.1 ± 10.8) patients. Visual analogue scale scores (VAS), radial cannulation failure (RCF), the rates of clinical and anatomical radial artery spasm (RAS), pain lasting >2day and >1 week, and radial artery occlusion (RAO) at first week and first month were evaluated in both groups. VAS scores, the rates of RCF, clinical and anatomical RAS and pain lasting >1week were found significantly lower in the study group than the control group (p < .001, p = .024, p=.009, p = .028 and p = .042, respectively). But the rates of RAO were similar in both groups. Topical spray including EC, which has low-cost and rapid efficacy, may be preferred in transradial coronary angiography as it reduces the risk of RCF and RAS, and increases patient comfort with its analgesic effect, without significant side-effects.

Analgesic effects of ethyl chloride spray in venepuncture – a prospective, randomized, controlled, single-blind study

Introduction and aim. This study evaluated whether ethyl chloride spray had an analgesic effect on pain intensity caused by venepuncture compared to a placebo. Material and methods. A total of 339 patients were randomly divided into two groups: The group in which ethyl chloride spray was applied (n=212) and the placebo group (n=127). The analgesic efficacy of ethyl chloride spray was compared with the placebo group using the Visual Analog Scale (VAS). Results. When the analgesic efficacy of ethyl chloride spray was compared with the placebo group, the VAS score was 4 [interquartile range (IQR): 1.0] for the ethyl chloride spray group and 5 (IQR: 2.0) for the placebo group. The efficacy of ethyl chloride spray in reducing pain was statistically significant compared to the placebo (p&lt;0.001). Conclusion. Ethyl chloride spray has analgesic activity in venepuncture. Therefore, this spray can be used at the emergency departments to reduce pain intensity in patients undergoing such interventions.

P67 Reducing the use of ethyl chloride spray in obstetrics with a cool new idea: a quality improvement project

P67 Reducing the use of ethyl chloride spray in obstetrics with a cool new idea: a quality improvement project

Cryoanesthesia with ethyl chloride spray versus 5% lidocaine gel in alleviating oral local anesthetic injection pain for buccal anaesthesia: A randomized clinical (controlled) trial.

Numbing the area of oral mucosa with cold application prior to administration of regional anesthesia has been widely used by various dentists in alleviating pain caused by needle prick. Cryoanesthesia using Endo-ice as topical anesthesia has been studied as a replacement to prevail the fallibility of topical anaesthetics. This study aimed to evaluate and compare effectiveness of ethyl chloride spray with 5% lidocaine gel in alleviating buccal anesthesia injection pain. Total of 90 outpatients were randomly divided into 3 groups as follows: Group 1 - cryotherapy with ethyl chloride at the anesthetic site preceding before administration of local anesthesia; Group 2 - topical application of 5% LIDOCAINE GEL preceding before administration of local anesthesia; and group 3 - control that did not receive any topical agent preceding before administration of local anesthesia. Visual analogue scale (VAS) was used to document pain immediately after injection prick. About comparison of pain scores, significant difference was found between group 1 (ethyl chloride) and group 2 (topical lidocaine) patients (P=0.001). For group 1, about 15 (50%) patients suffered from mild pain, followed by 14 (46.67%) patients suffering from moderate pain. However, majority of the 21 (70%) patients in group 2 suffered from moderate pain. All the patients in group 3 suffered from severe pain. Importance of alleviating fear of needle injection phobia amongst patients is of paramount importance. Ethyl chloride was found to be more effective than topical lidocaine in alleviating needle injection pain before administration of local anesthetic injection.

Ethyl chloride spray, a local anesthetic in arterial blood gas sampling: A randomized, controlled, double-blinded study

AimArterial blood gas sampling provides useful information on respiratory parameters and acid-base balance. However, this procedure is painful and uncomfortable for the patient. Therefore, this study aimed to examine the analgesic efficacy of ethyl chloride spray compared to a placebo during radial artery blood gas sampling. MethodThis randomized, double-blind, placebo-controlled study was conducted at the emergency department of a tertiary hospital. A total of 202 patients were randomly divided into two groups: ethyl chloride spray (n = 101) and placebo (n = 101). The analgesic efficacy of ethyl chloride spray was compared with the placebo using the Visual Analog Scale (VAS). ResultsThe VAS score was determined to be 4 [interquartile range (IQR): 1.0] for the ethyl chloride spray group and 5 (IQR: 1.0) for the placebo group. The analgesic efficacy of ethyl chloride spray in reducing pain was statistically significantly higher compared to the placebo (p = 0.000). ConclusionEthyl chloride spray has analgesic efficacy in arterial blood gas sampling. Therefore, the use of this spray provides an analgesic effect on patients during arterial blood gas sampling performed in the emergency department.

Comparison of pain-reducing effect between topical ethyl chloride spray versus subcutaneous 1% lidocaine injection during two rods system contraceptive implant insertion: A randomized controlled trial.

To compare the effectiveness of topical ethyl chloride spray (ECS) and subcutaneous 1% lidocaine injection (LI) to reduce pain during the two rods system insertion. One hundred and ten women, who underwent two rods contraceptive implant insertion during January 2021 to July 2021, were enrolled and randomly allocated to ECS and 1% LI groups. After the skin was sterilized, the assigned anesthetic method was administered before insertion of two rods contraceptive implant using the standard procedure. Pain levels during; (1) the administering of the anesthetic, (2) the insertion of the implant, (3) at 20min after insertion and (4) overall pain levels, were evaluated, using a 10 levels visual analogue scale (VAS). All basic clinical characteristics between the two groups showed no significant difference. Mean VAS during anesthetic in the ECS group were significantly lower than in the LI group (3.92 and 2.89, mean difference -1.03, 95%CI -1.76 to -0.31, p<0.01). However, the mean VAS during; (1) implant insertion, (2) 20min after implant insertion and (3) overall pain, in the ECS group were significantly higher than in the LI group (4.83, 1.61, 3.11 versus 0.98, 0.09, 1.66) (mean difference 3.85, 1.52, 1.44 (95%CI 3.12 - 4.58, 1.13 - 1.92, 0.97 - 1.92, p<0.01)). ECS should not be used solely as an anesthetic option for the two rods system of implant insertion. It provides for less pain during the administering of the anesthetic but significantly less analgesic effect than LI.

Comparative Efficacy of EMLA Cream and Ethyl Chloride Spray for Reducing the Venipuncture Pain During Intravenous Cannulation

Background and Objectives: Intravenous Cannulation is a pain full procedure. Pain associated with intravenous cannulation can be decreased by using local anaesthetics. This study was conducted to evaluate the efficacy of EMLA cream against the reduction of the venipuncture pain during IV cannulationin comparison with Ethyl chloride spray. Methods: This single center, prospective randomized study with two parallel groups was conducted at Department of Anaesthesiology, Critical Care and Pain Management, S.S Institute of Medical Sciences, Davanagere. A total of 100 subjects admitted due to various illnesses were enrolled into the study. Study subjects were randomly divided into two groups viz. G1 and G2 with 50 subjects in each group. Subjects in G1 were anesthetized with topical application of EMLA cream, and in G2 with Ethyl Chloride spray. Results: The results of VAS score depicted that following application of EMLA cream causes mild venepuncture pain during intravenous cannulation, whereas Ethyl chloride spray causes moderate venepuncture pain during intravenous cannulation. Furthermore, our study findings delineated that EMLA cream was safe to use without any side effects when compared to Ethyl chloride spray wherein burning sensation, itching and redness like side effects were experienced by study subjects. Conclusion: EMLA cream is safe and effective in reduction of venipuncture pain during IV cannulation. Keywords: EMLA cream; Ethyl chloride spray; Pain; IV cannulation; VAS; Efficacy; Safe.

Comparison of the Effectiveness between 5% Eutectic Mixture of Local Anesthetic Cream and Ethyl Chloride Spray Applied on the Skin Prior to Intravenous Cannulation

Background: Since the patients scheduled for an endoscopic procedure had been unhappy with pain during intravenous cannulation. Objective: To compare the effectiveness between 5% eutectic mixture of local anesthetic cream and ethyl chloride spray applied on the skin prior to the procedure. Materials and Methods: One hundred eighty-six patients were randomized equally into three groups, A: 5% eutectic mixture of local anesthetic cream, B: ethyl chloride spray, and C: placebo. Then a nurse used a 22-gauge (22G) needle catheter to administer a cannula. Five minutes after the intravenous cannulation, a co-researcher assessed the patient’s pain perception and satisfaction as well as the nurse’s difficulty in performance by means of a numeric rating scale. Results: One hundred seventy-six patients completed the present study. Participants having the anesthetic cream and spray application as well as the placebo expressed their pain scores as 1.7±1.3, 1.6±1.2, and 2.2±1.3, respectively. Therefore, patients applied with local anesthetics had significantly less pain perception than those with the placebo (p=0.039); however, scores were not different between the anesthetic cream and the spray groups. Conclusion: Patients scheduled for an endoscopic procedure did not showed significant pain relief with either the 5% eutectic mixture of local anesthetic cream or the ethyl chloride spray. Keywords: 5% eutectic mixture of local anesthetic cream, Ethyl chloride spray, Endoscopic surgery, Intravenous cannulation, Pain

83 Evaluation of transmammary-delivered firocoxib and an ethyl chloride spray to mitigate pain associated with processing procedures in piglets

Abstract Piglets raised in commercial production systems in the U.S. undergo painful management procedures, including surgical castration, tail docking and ear notching, without analgesia or anesthesia provision for pain relief. This is a significant animal welfare concern. There is an immediate need to identify the most practical and effective analgesia or anesthesia option for use on-farm. The objective of this study was to assess the efficacy of 2.0mg/kg firocoxib, administered to the sow and delivered transmammary to her piglets, and a vapocoolant spray (ethyl chloride) to reduce processing pain. Five-day old male and female Yorkshire-cross piglets were used. 2.0mg/kg firocoxib was administered to the sow intramuscularly 7h prior to processing piglets. An ethyl chloride spray was applied to the ears, tail and scrotum of the piglets immediately before ear notching, tail docking and surgical castration, respectively. Piglets were assigned to one of four treatment groups: firocoxib and vapocoolant spray (FV; n=32), firocoxib only (F; n=32), vapocoolant spray only (V; n=32), no treatment (CON; n=32). The observation period was from 24h pre- to 48h post-processing (specific time points = baseline, 0h, 1h, 2h, 4h, 7h, 24h, 30h, 36h, 48h). Preliminary results found piglets displayed significantly more pain-related behaviors at 24h and 30h post-processing than at most other time points (p&amp;lt; 0.05). Piglets had significantly higher cranial temperatures at 7h post-processing than all other time points (p&amp;lt; 0.05). There was a trend in FV and F piglets having a higher cranial temperature at 36h post-processing compared to V and CON piglets (p=0.08). All piglets had significantly higher hair cortisol levels at 4 vs 20-days old (p&amp;lt; .0001); however, there were no significant treatment effects on cranial temperature, hair cortisol or pain behavior, suggesting firocoxib and the ethyl chloride spray were unable to significantly reduce piglet pain post-processing. Further study analysis is needed to confirm these initial findings.

Reduction in pain from corticosteroid injection for the treatment of trigger finger with subcutaneous single-injection digital block: a randomized controlled trial.

The pain from corticosteroid injections is not an insignificant issue for patients with trigger finger. The aim of this study was to evaluate the efficacy of subcutaneous single-injection digital block (SSIDB) for pain reduction during trigger finger corticosteroid injection. Ninety patients requiring corticosteroid injections for trigger finger were randomized to three groups: SSIDB with 2ml of 1% lidocaine, SSIDB with 1ml of 1% lidocaine and no digital block (control group). In SSIDB groups, the intrasynovial corticosteroid injections were performed after digital nerve block. In control group, ethyl chloride spray was applied prior to intrasynovial injection of the corticosteroid and 1% lidocaine mixture. The pain during lidocaine needle insertion, lidocaine infiltration, corticosteroid needle insertion and corticosteroid infiltration were determined with a visual analog scale (VAS). The VAS pain scores for corticosteroid needle insertion in both SSIDB groups were significantly lower than the VAS pain scores in control group (p < 0.001). The VAS pain score during corticosteroid infiltration in 2ml of 1% lidocaine group was significantly lower than 1ml of 1% lidocaine group (p = 0.008), and in control group (p < 0.001). Pain during nerve block procedure in both SSIDB groups was significantly lower than the pain from corticosteroid injection in the control group (p < 0.05 and p < 0.05). Subcutaneous single-injection digital block with 2ml of 1% lidocaine was highly effective in reducing pain associated with injection of corticosteroid for trigger finger.

Effect of Ethyl Chloride Spray versus Ice Pack Application on Pain Perception in Patients Undergoing Radial Arterial Puncture: A Randomised Controlled Tria

Introduction: Radial Arterial Puncture (AP) is much needed procedure in critical care setting but pain associated during AP makes patients anxious and stressed. Aim: To evaluate the efficacy of ethyl chloride spray versus ice pack application in decreasing pain during puncture of radial artery for Arterial Blood Gas (ABG) analysis. Materials and Methods: A randomised controlled parallel group design study was conducted in a tertiary care hospital in critical care units among 60 participants during November 2018 to December 2018. Seventy-two participants were initially recruited for this study who had to undergo ABG analysis out of them 12 were excluded and finally 60 participants were randomly allocated to ethyl chloride spray group (n=30) and ice pack application group (n=30). The assigned treatment was given just prior to radial AP. The primary outcome variable was to assess the level of pain score, which participants experienced during AP and measured by pain numerical rating scale while secondary outcome variable was incidence of haematoma within two hours after procedure. Data were presented in frequency, percentages, chi-square, Mann-Whitney U and Fisher’s-exact test. The statistical computer package, IBM Statistical Package for the Social Sciences (SPSS 23.0) was used for statistical analysis. Results: The mean pain score was 2.5±1.2 in the ethyl chloride group and 3.1±1.8 in ice pack application group (p=0.113); while incidence of haematoma was significantly high in ice pack application group as compared to ethyl chloride group (33.3% vs. 6.66%; p=0.01). Conclusion: Ethyl chloride spray and ice pack application have no significant difference in reducing pain intensity due to radial AP

Sterility of Ethyl Chloride Spray After Use in the Clinic.

Background: Ethyl chloride spray is used frequently in the outpatient setting as a local anesthetic for injections and aspirations with varying consensus about the sterility of the spray. We hypothesize that ethyl chloride spray remains sterile and would show no bacterial growth during routine clinical use. Methods: Thirteen ethyl chloride bottles were collected for testing. Two unopened bottles were used as controls. Eleven unopened bottles were placed in orthopedic clinics and recollected after varying duration of use. The final volume and duration of use were recorded. Each bottle was sprayed in a separate test tube and allowed to evaporate. Trypticase soy broth was added to each tube and incubated for 48 hours. Control test tubes with broth alone were prepared and incubated under the same conditions. Cultures were evaluated at 24 and 48 hours. Results: The mean duration of ethyl chloride bottle use prior to culturing was 26 days. The average volume used per day was 1.9 mL. Each ethyl chloride bottle had an initial volume of 103.5 mL. Using the average daily volume usage, an extrapolated lifespan of each bottle was estimated at 7.7 weeks. None of the samples showed bacterial or fungal growth at 24 or 48 hours. Conclusion: Ethyl chloride bottles used in the clinical settings showed no bacterial or fungal contamination through their shelf life and routine use. The duration and amount of use did not affect sterility. Although the antimicrobial activity of ethyl chloride spray on skin is debated, ethyl chloride itself remains sterile through clinical use.

Effectiveness of Different Techniques of Ethyl Chloride Spray for Venepuncture-Induced Pain: A Randomised Controlled Trial.

Background:Venepuncture is an essential component of anaesthesia services. However, this invites pain generating the first negative experience with anaesthesia. Hence, relief of this pain carries considerable importance. Efficacy of ethyl chloride spray although studied, there is no consensus for the best way of application.Objectives:The present study was conducted to find an effective technique/method of ethyl chloride spray application to reduce venepuncture pain.Methods:Adult patients posted for different anaesthesia procedures were randomised into three groups. Venepuncture was done either after installation of distilled water or spray of ethyl chloride either once to twice. Venepuncture pain was assessed with a 0-100 Numeric Rating Scale.Results:The analysis showed significant differences among the groups (F [2,96] = 66.27, P < 0.05). The twice sprayed group experienced the least pain ([mean ± standard deviation [SD]] 16.67 ± 10.21), lower in the once spray group ([mean ± SD] 27.58 ± 13.24), and the controls had the highest pain score ([mean ± SD] 49.09 ± 11.28). Post hoc Tukey's tests showed all the three groups differed significantly. The effect size was large, and the variability of the spray on the reduction of pain scores is 58% (η2 = 57.99).Conclusion:Ethyl chloride spray effectively reduces the pain on venepuncture, especially when the vapocoolant is sprayed twice each over 5 s, and from a distance of 5 cm perpendicular to the skin.

Anomalous point-of-care ketone reading following use of ethyl chloride spray as a topical anaesthetic during the treatment of a teenager with DKA

Anomalous point-of-care ketone reading following use of ethyl chloride spray as a topical anaesthetic during the treatment of a teenager with DKA

Gabapentin and NMDA receptor antagonists interacts synergistically to alleviate allodynia in two rat models of neuropathic pain.

Background and aims The clinical management of neuropathic pain remains a challenge. We examined the interaction between gabapentin and NMDA receptor antagonists dextromethrophan and MK-801 in alleviating neuropathic pain-like behaviors in rats after spinal cord or sciatic nerve injury. Methods Female and male rats were produced with Ischemic spinal cord injury and sciatic nerve injury. Gabapentin, dextromethorphan, MK-801 or drug combinations were injected with increasing doses. Mechanical response thresholds were tested with von Frey hairs to graded mechanical touch/pressure, and ethyl chloride spray was applied to assess the cold sensitivity before and after injuries. Results In spinally injured rats, gabapentin and dextromethorphan did not affect allodynia-like behaviors at doses of 30 and 20 mg/kg, respectively. In contrast, combination of 15 or 30 mg/kg gabapentin with dextromethorphan at 10 mg/kg produced total alleviation of allodynia to mechanical or cold stimulation. Further reducing the dose of gapapentin to 7.5 mg/kg and dextromethorphan to 5 mg/kg still produced significant effect. MK-801, another NMDA receptor antagonist, also enhanced the effect of gabapentin in spinally injured rats. Similar synergistic anti-allodynic effect between dextromethorphan and gabapentin was also observed in a rat model of partial sciatic nerve injury. No increased side effect was seen following the combination between gabapentin and dextromethorphan. Conclusions In conclusion, the present study suggested that combining NMDA receptor antagonists with gabapentin could provide synergistic effect to alleviate neuropathic pain and reduced side effects. Implications Combining NMDA receptor antagonists with gabapentin may provide a new approach in alleviating neuropathic pain with increased efficacy and reduced side effects.

Ethyl chloride spray for musculoskeletal ultrasound-guided injections: An alternative to subcutaneous injection of local anesthetic solution.

Ultrasound-guided injections such as steroid injections are common procedures involving the musculoskeletal system. They are usually performed after a subcutaneous injection of local anesthetic (LA), which can be painful. In 126 consecutive patients, local anesthesia was performed using ethyl chloride spray prior to a therapeutic ultrasound-guided injection in joints, tendons, or bursae. Ninety-nine (78.5%) patients found the use of ethyl chloride spray helpful. The use of ethyl chloride spray is an effective, patient-friendly alternative to the standard injection of local aesthetic for ultrasound-guided therapeutic musculoskeletal injections with the advantage of a lower cost of $0.18 per procedure.

Use and Effectiveness of Ethyl Chloride for Hand Injections

Limited literature supports using ethyl chloride topical spray as an anesthetic for hand injections whereas documented risks include frostbite, skin irritation, and inhalation toxicity. We hypothesize that ethyl chloride spray imparts no benefit to patients' perception of pain or anxiety for routine hand injections. We first surveyed all members of the American Society for Surgery of the Hand to discern the prevalence of ethyl chloride use during routine injections. We then performed a prospective, randomized, study at 2 institutions evaluating the efficacy of ethyl chloride spray compared with "routine injection" (no topical spray) in patients indicated for a hand injection. All patients completed a pre- and postinjection 11-point questionnaire that inquired about various components of pain and anxiety. A total of 2,083 (73% response rate) American Society for Surgery of the Hand members responded to the survey and revealed that 59% of hand surgeons always or often use ethyl chloride, and 24% never use it. There were no differences for region or practice setting, but experienced surgeons were less likely to routinely use ethyl chloride (35%) compared with younger surgeons (66%). Among 151 patients participating in the clinical study (75 with ethyl chloride), there were no differences for any outcome measure assessed. Injection pain in the spray and no-spray groups, pain after 1 minute, and overall anxiety were equivalent. Subgroup analysis demonstrated no effect of sex, anticipated anxiety, or pain threshold. Ethyl chloride is widely used among hand surgeons but imparts no benefit for routine hand injections in the clinical setting. The potential risks and costs of ethyl chloride use may outweigh its benefits. Therapeutic II.