Track: Clinical Studies

Abstract:

Jet injectors are a needle-free method of delivering local anesthesia with compressed CO2 gas that reduces pain and anxiety associated with needles. However, the histologic effects on skin biopsy specimens has not been well studied. This pilot study evaluated whether lidocaine delivery via jet injectors introduces histologic artifact or compromises diagnostic interpretation compared to standard 30-gauge needles. Ten biopsy specimens were obtained from seven volunteers: eight following jet injections (seven shave biopsies and one punch biopsy) and two following 30-gauge needle injections (both shaves). All participants reported complete anesthesia immediately after jet injection; including with the punch biopsy. Specimens were processed routinely, and slides were reviewed by a dermatopathologist blinded to the anesthesia method. The pathologist was unable to reliably distinguish which specimens were treated with jet injection and which were treated with 30-gauge needle injection. One jet-injected specimen showed focal loss of epidermis over a jet injection artifact that required deeper sections, but this did not interfere with establishing a diagnosis. Overall, jet injector use did not compromise histopathologic interpretation. These findings suggest that jet injectors are a viable, less painful alternative to needle-based lidocaine delivery for skin biopsies. They may be particularly useful for small lesions in pediatric or patients with trypanophobia (needle phobia). We recommend using the jet injector adjacent to, rather than directly through, lesions, especially when the suspected pathology is primarily an epidermal process, to minimize the risk of artifact. Larger studies are warranted to validate these findings and optimize usage guidelines.

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Kimberly Eisenstein