One hundred sixty-five patients with Kellgren-Lawrence grade II–III–IV knee osteoarthritis were randomized to receive vapocoolant spray (n=55), placebo saline spray (n=55), or no analgesic treatment (n=55) prior to intra-articular hyaluronic acid injections. The primary outcome was pain during needle penetration assessed by a 100-mm visual analog scale (VAS). Secondary outcomes included preinjection anxiety levels, patient satisfaction, and functional outcomes measured by the WOMAC index at baseline and 1 week. Outcomes were assessed immediately after the procedure and at 1-week follow-up. Overall, the results showed that both the vapocoolant and placebo sprays reduced needle-stick pain compared with no analgesic pretreatment, but there was no significant difference between the vapocoolant and placebo groups. The findings suggest that while vapocoolant spray meets patients’ expectations of pain relief during knee injections, it does not offer a significant advantage over placebo.