Could a two-stage injection technique cause less pain?

two-stage injection

A new study has shown a two-stage injection could cause less pain to patients

A two-stage injection technique could cause less pain for children, a new study has shown.

The study, published in Anesthesia Progress, looked at ways to reduce the pain associated with local anaesthetic injections, focussing on children between seven and 13 years of age.

The authors of the study found that by placing a gel anesthetic in the gum area, depositing a small amount of injectable anesthetic, and then waiting five minutes, the full injection was far less painful

‘It’s a simple and effective means of reducing injection pain in children,’ the authors concluded about the two-stage injection.

Two-stage injections

A two-stage injection significantly reduced pain levels reported by the children and observed by the researchers.

The authors evaluated the pain experienced by each child each time an injection was given, using a pair of rating scales.

The full text for the article can be found at


  1. 1

    Ive been using this technique for 40 years and it works well – not just for children.
    The local anaesthetic should be warmed to body temperature in the hand prior to injection.
    The dual injection technque works very well especially for the richly innervated areas around the anterior teeth.
    The other option is to ask the patient to time a cough with needle insertion. This affords some distraction and maybe is effective via the gate pathway.

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    I’ve found this works well with IDBs also. Use a small amount of LA with a short tip to anaesthatise the superficial tissues before returning to place the definitive injection.

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    I also have used this technique successfully for over 35 years. Particularily works great with Articaine infiltrations. Articaine seems to sting more and this technique minimizes this. Also great for upper anterior anesthetic as Professor Peckitt said. Don’t understand why a study had to be done to prove what many of us have been doing for our entire careers.

  7. 7

    Well I was taught this by my tutor at uni and must say it works magic… Love the cough or any distraction technique whilst injecting :-)

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