Substitute for Lidocaine

What options are available to minimize the pain associated with goserelin (Zoladex) injections, given the recent shortage of sterile lidocaine for injection? — Name withheld on request

Some institutions standardly administer an injection of lidocaine to numb the injection site prior to subcutaneous injection of goserelin.

Two small studies in Japan investigated use of goserelin in men with prostate cancer. The patients received one goserelin injection with no intervention and one injection after undergoing numbing with an ice pack (applied for one-half to 2+ minutes). Both studies showed significant reductions in injection pain when patients underwent numbing prior to the injection. When asked, patients expressed a preference for numbing the area prior to their injections.

Based on this information and recommendations from the goserelin manufacturer, numbing the injection site with an ice pack is a reasonable option to minimize pain associated with goserelin injections.