The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.