Fractional CO2 laser assisted delivery of topical anesthetics: A randomized controlled pilot study

Background and Objectives Many dermatological procedures are performed under local anesthesia. Topical anesthesia requires prolonged occlusion and is often insufficient. Infiltration anesthesia is associated with discomfort. Pretreatment with an ablative fractional laser (AFXL) may enhance penetrati...

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Bibliographic Details
Published in:Lasers in surgery and medicine 2016-02, Vol.48 (2), p.208-211
Main Authors: Meesters, Arne A., Bakker, Myrna M., de Rie, Menno A., Wolkerstorfer, Albert
Format: Article
Language:English
Subjects:
Adult
Anesthetics, Local - administration & dosage
Carticaine - administration & dosage
drug delivery
Drug Delivery Systems
Female
fractional laser
Healthy Volunteers
Humans
Lasers, Gas
Lidocaine - administration & dosage
Male
Pain Measurement
Pilot Projects
Prilocaine - administration & dosage
Prospective Studies
Single-Blind Method
topical anesthesia
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Summary:Background and Objectives Many dermatological procedures are performed under local anesthesia. Topical anesthesia requires prolonged occlusion and is often insufficient. Infiltration anesthesia is associated with discomfort. Pretreatment with an ablative fractional laser (AFXL) may enhance penetration of topical drugs, including lidocaine. Primary aim of this study was to assess whether AFXL pretreatment enhances the efficacy of two regularly used anesthetics: (i) articain hydrochloride 40 mg/ml + epinephrine 10 μg/ml solution (AHES); (ii) lidocaine 25 mg/g + prilocaine 25 mg/g cream (EMLA cream). Secondary aim was to assess which anesthetic is superior on AFXL pretreated skin. Materials and Methods In 10 healthy subjects, four 1 cm2 test regions on the back were randomized to [A] AFXL pretreatment (fractional CO2 laser, 5% density, 2.5 mJ/microbeam) + topical application of AHES, [B] AFXL pretreatment + EMLA cream, [C] sham AFXL + AHES, and [D] sham AFXL + EMLA cream. After ten minutes, an AFXL pass (35 mJ/microbeam) was given as pain stimulus at each test region. Pain was scored on a 0–10 visual analogue scale (VAS) after each stimulus. Results AFXL pretreatment was not considered painful. Median VAS scores for the pain stimulus were [A] 2.35, [B] 3.15, [C] 4.55, and [D] 4.35. VAS scores were significantly lower for region [A] (AFXL + AHES) versus region [B] (AFXL + EMLA; P 
ISSN:0196-8092
1096-9101
DOI:10.1002/lsm.22376