Percutaneous needle aponeurotomy is an effective minimally invasive treatment for Dupuytren’s disease, but infiltration of local anaesthetic into the palm is often painful. Vapocoolant sprays produce rapid cutaneous cooling and may reduce nociceptor activation, yet evidence in hand surgery is limited. This randomised controlled trial evaluated whether vapocoolant application before local anaesthetic infiltration reduces injection pain during percutaneous needle aponeurotomy. In a single centre, single blind design, adults undergoing percutaneous needle aponeurotomy were randomised 1:1 to receive vapocoolant spray immediately before infiltration with one percent plain lignocaine or lignocaine alone. Only the first injection was assessed. The primary outcome was injection pain measured using a ten point visual analogue scale. Secondary outcomes included immediate adverse events. Exploratory analyses examined associations between pain scores and demographic or disease variables. Ninety four patients were analysed, with forty seven in each group. Vapocoolant application resulted in a significant reduction in mean injection pain compared with control, with a mean difference of 2.7 visual analogue scale units. This exceeded the reported minimal clinically important difference for acute procedural pain. No adverse events or complications were observed in either group. Increasing age demonstrated a moderate positive association with reported pain. Pre infiltration vapocoolant spray significantly reduced injection pain during percutaneous needle aponeurotomy without compromising safety. Given its rapid onset, negligible cost, and ease of use, vapocoolant spray represents a practical analgesic adjunct that may improve patient comfort and procedural tolerability in hand surgery.