Injection of local anaesthetic into the palmar tissues during percutaneous needle aponeurotomy for Dupuytren’s disease can be painful. Commercial lignocaine is acidic, and buffering with sodium bicarbonate may reduce infiltration discomfort by raising pH toward physiological levels. Needle gauge may also influence pain at needle entry. This randomised controlled trial evaluated the effects of lignocaine buffering and needle gauge on patient reported pain during percutaneous needle aponeurotomy. In a single centre, single blind, randomised design, adults undergoing percutaneous needle aponeurotomy were allocated to receive either one percent lignocaine buffered with 8.4 percent sodium bicarbonate at a 10 to 1 ratio or plain one percent lignocaine. Participants were also allocated to infiltration using either a 25 gauge or 27 gauge needle. Pain was recorded on a ten point visual analogue scale, separately for needle insertion and for local anaesthetic infiltration. Immediate adverse events were recorded. Sixty seven patients were included. Buffered lignocaine significantly reduced infiltration pain compared with plain lignocaine, with a mean reduction of 1.65 visual analogue scale points and no adverse events. Needle gauge did not significantly affect needle insertion pain, with no meaningful difference between 25 gauge and 27 gauge needles. Buffering lignocaine with sodium bicarbonate is a simple, safe, and cost effective method to reduce infiltration pain during percutaneous needle aponeurotomy. Within the tested range, needle gauge does not meaningfully alter needle insertion pain.