Background: Botulinum toxin A (Botox) therapy is safe and effective for hemifacial spasm, however, the associated discomfort and pain from injections limit its usefulness.

Objective: To evaluate pain, preparation difficulty, and satisfaction following application of a eutectic mixture of local anesthetic (EMLA) cream, ice application, and placebo before Botox injections for hemifacial spasm.

Materials and Methods: Twenty-two patients received four Botox injections in the facial area to treat hemifacial spasm, between June 2022 and March 2023. The initial treatment began in June 2022, followed by treatments at 3, 6, and 9 months. The EMLA cream, ice application, control, and placebo were administered consecutively for each Botox treatment. Pain, preparation difficulty, and satisfaction were evaluated on a 0 to 10 scale. Neurological and bleeding complications were recorded.

Results: The mean pain score for EMLA cream application was the lowest, followed by cold compressions. The mean pain score in the control with placebo intervention was not significantly different from that in the control. The control without placebo intervention had the lowest difficulty in preparation score at 0.82 and showed no significant difference with EMLA application. Whereas cold compression had the highest difficulty in preparation score. The highest satisfaction score was obtained with the EMLA cream application at 9.45. The satisfaction score was higher in the control with placebo intervention at 8.32 than in the control, which had the lowest satisfaction score at 6.91. The number of injections and neurological complications did not differ among the four methods. The bleeding site ratio was the lowest with the cold compression method.

Conclusion: EMLA cream application resulted in the lowest mean pain and the highest satisfaction scores. Control with placebo intervention increased the satisfaction score without reducing the mean pain score. Cold compression decreased bleeding complications, and the secondlowest mean pain scores.

Keywords: Ice; Local anesthetics; EMLA; Hemifacial spasm; Botox injection; Pain reduction

DOI: 10.35755/jmedassocthai.2023.11.13908

Received 4 August 2023 | Revised 26 September 2023 | Accepted 3 October 2023