John is a 3-year-old who is scheduled to receive his first subQ injection of Neupogen. What would NOT be an appropriate strategy to decrease the pain associated with a SC injection?

• A. Use of ice and insuflon catheter
• B. Use of LMX cream
• C. Use of distraction
• D. Use of buffered lidocaine

Answer: (D)

The key idea is reducing needle-related pain by methods that avoid adding extra injections and minimize tissue sensation changes. Topical anesthetics like LMX cream are applied to the skin well before the shot to numb the surface nerves without another needle poke. Ice briefly on the skin can slow nerve conduction and lessen pain, and distraction helps shift the child’s attention away from the needle.

Buffering lidocaine implies delivering a local anesthetic by injection to numb the site first. That would mean an additional needle stick just to numb the area, which defeats the purpose of reducing pain for the actual subcutaneous injection and can add delay and small-risk exposure in a young child. So, while buffering lidocaine can reduce pain in some procedures, it’s not appropriate here because it creates an extra painful step rather than preventing the pain of the Neupogen injection itself.