LIDOCAINE spray significantly reduced pain during rabies immunoglobulin infiltration and improved satisfaction in a randomized trial.
Rabies immunoglobulin infiltration is an essential component of care for some people following rabies exposure, but administration can be intensely painful. Researchers evaluated whether topical 10% lidocaine spray could reduce pain during both needle penetration and immunoglobulin infiltration.
The single center, double blind, placebo-controlled superiority trial enrolled 76 adults aged 18 to 65 years who required rabies immunoglobulin at a university hospital in Bangkok. Participants were randomly assigned in equal numbers to receive lidocaine spray or placebo.
People with major organ disease, contraindications to lidocaine, or recent analgesic use were excluded. Pain was measured using a 100 mm visual analog scale through 30 minutes after infiltration. Satisfaction was assessed using a 10 point Likert scale.
Baseline median pain scores were comparable between the groups after adjustment for wound type and size.
During needle penetration, the median pain score was 25.0 in the lidocaine spray group, compared with 56.5 in the placebo group. The adjusted median difference was −30.8 points, with a 95% confidence interval of −43.6 to −18.0.
A similar effect was observed during rabies immunoglobulin infiltration. Median pain was 46.5 with lidocaine spray and 77.0 with placebo, producing an adjusted median difference of −33.0 points. Both reductions were statistically significant.
Participants receiving lidocaine spray also reported greater satisfaction. Median satisfaction was 8.0 out of 10, compared with 6.0 among those receiving placebo.
No adverse effects were reported in either group during the 30 minute observation period. The findings indicate that 10% lidocaine spray provided both statistically and clinically significant relief during needle penetration and rabies immunoglobulin infiltration.
The results support lidocaine spray as a simple option for procedural pain control in adults with the eligible small to moderate wound types evaluated. However, the evidence comes from 76 adults at one center, and the study excluded patients with several important clinical considerations. Its findings therefore should not be assumed to apply to children, older adults, larger or more complex wounds, or people with lidocaine contraindications.
Reference
Areeraksakul P et al. Efficacy of lidocaine spray for pain reduction during rabies immunoglobulin infiltration: a double-blind, randomized, placebo-controlled trial. Vaccine. 2026;92:129141.
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