Iontophoresis of Lidocaine for Anesthesia during Pulsed Dye Laser Treatment of Port‐Wine Stains

Abstract

Port-wine stains may be effectively ablated using the pulsed dye laser emitting at a wavelength of 577 or 585 nm. However, the discomfort of this therapy may be severe enough to require reduction of treatment duration thereby increasing the need for repeat sessions. Currently available methods of anesthesia or sedation for pulsed dye laser therapy have drawbacks to their use. We performed a prospective double-blind, placebo-controlled evaluation of the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 for local anesthesia during pulsed dye laser ablation of port-wine stains. Eleven patients with port-wine stains completed the initial phase of the study. Pain scale evaluation by patients demonstrated significant decreases in the discomfort of pulsed dye laser impulses by the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 (P less than .0001), with no significant difference between these treatments. Follow-up evaluation suggests that iontophoresis has no detrimental effect on pulsed dye laser ablation of port-wine stains, despite significant decreases in perfusion, as measured by laser Doppler velocimetry, of port-wine stain areas receiving iontophoresis of lidocaine with epinephrine. Iontophoresis of lidocaine HCl 4% with or without epinephrine is a safe and effective method of local anesthesia for pulsed dye laser therapy.

The Relation between Epinephrine Concentration and the Anesthetic Effect of Lidocaine Iontophoresis

“…Small, portable, self‐contained iontophoresis devices have been recently developed, making their use for anesthesia practical in a dermatologic setting. Several studies have described the iontophoretic delivery of lidocaine 1–3 . At present, dermal anesthesia can be achieved fairly rapidly using lidocaine iontophoresis without needles 4–6 …”

Lidocaine Iontophoresis for Local Anesthesia Before Shave Biopsy

“…Lidocaine iontophoresis for anesthesia before pulsed dye laser therapy has been more extensively studied 23,24 . Thirty‐nine patients ranging in age from 6 to 39 were enrolled in a double‐blind, placebo‐controlled trial in which 13 received lidocaine 5%, 13 received mepivacaine 2%, and 13 received placebo.…”

Lidocaine Iontophoresis for Topical Anesthesia Before Dermatologic Procedures in Children: A Randomized Controlled Trial

“…The efficacy of lidocaine iontophoresis for anesthesia prior to pulsed dye laser treatment of port‐wine stains has also been evaluated (20,21). Nunez et al (21) studied 39 patients ranging in age from 6 to 39 years in a double‐blind, placebo‐controlled study where 13 received lidocaine 5% with epinephrine, 13 received mepivacaine 2% with epinephrine, and 13 received placebo.…”