Clinical comparison of preinjection anesthetics

To minimize injection anxiety and discomfort, the podiatric surgeon can choose from a variety of topical anesthetics. Available modalities include skin refrigerants (also referred to as vapocoolants), needleless injection systems, iontophoresis, and eutectic mixtures of topical anesthetic cream such as EMLA Cream. Many of the vapocoolants contain chlorofluorocarbons, which are known to damage the ozone layer, a stratospheric layer that filters out harmful ultraviolet B radiation. In accordance with the 1992 Montreal Protocol, which banned the manufacture of certain chlorofluorocarbon compounds, many commonly used vapocoolants will no longer be available. Some newly marketed vapocoolants produce extremely cold temperatures, limiting their use. This article discusses the properties of various vapocoolants and other topical anesthetics and compares their effectiveness in patient trials.