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A Prospective, Randomized Controlled, Single-Blinded Study to Assess the Effect of a 33-Gauge Needle Versus a

Kourosh Beroukhim, Paige H Williams, Leonard H Goldberg

    Journal of Drugs in Dermatology : JDD
    |November 9, 2023
    PubMed
    Abstract

    Insights

    A 34-gauge needle significantly reduces pain during Mohs surgery injections compared to a 33-gauge needle. This finding is most relevant for specific patient groups, offering improved comfort during the procedure.

    Area of Science:

    • Dermatology
    • Surgical Procedures
    • Pain Management

    Background:

    • Pain during Mohs surgery is primarily linked to local anesthetic injection.
    • Previous research indicates smaller gauge needles (e.g., 33-gauge vs. 30-gauge) reduce patient-reported pain.

    Purpose of the Study:

    • To compare patient-reported pain levels after injections using 33-gauge versus 34-gauge needles during Mohs surgery.
    • To identify patient subgroups that benefit most from the finer needle gauge.

    Main Methods:

    • Prospective, randomized, single-blinded study involving 480 patients.
    • Patients were randomized to receive injections with either a 33-gauge or 34-gauge needle.
    • Pain was assessed using the validated numerical rating scale (VNRS)-11.

    Main Results:

    • Injection with a 34-gauge needle resulted in significantly lower pain scores (0.49) compared to a 33-gauge needle (0.79) (P=0.007).
    • Greater pain reduction was observed in females, first-time Mohs patients, individuals under 65, basal cell carcinoma patients, and those with nasal tumors.

    Conclusions:

    • Both 33-gauge and 34-gauge needles are well-tolerated with minimal pain during Mohs surgery.
    • The 34-gauge needle offers a statistically significant reduction in pain, with potential clinical relevance for specific patient populations.

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