Laser-Assisted Penetration of Topical Anesthetic in Adults

Abstract

Objective: To determine whether pretreatment of skin with erbium:YAG (Er:YAG) laser-assisted delivery facilitates the penetration of lidocaine cream to provide anesthesia suitable for needlesticks after just 5 minutes.Design: Trial 1 was a double-blind randomized controlled trial, whereas trial 2 was a nonblinded randomized controlled trial. Setting:The study was conducted in 2 facilities, an academic and a private clinical research unit.Participants: A total of 320 healthy volunteers, aged 18 to 65 years and of any Fitzpatrick skin phototype.Interventions: Trial 1 involved an Er:YAG laser pretreatment to disrupt the stratum corneum followed by an application of 4% lidocaine cream on one arm, and a laser pretreatment plus placebo on the other arm. Trial 2 involved an application of 4% lidocaine cream alone on one arm, and a laser pretreatment followed by an application of 4% lidocaine cream on the other arm.Main Outcome Measure: Self-reported pain perception on a 100-mm visual analog scale after quick insertion and removal of a 25-gauge hypodermic needle on the treatment sites.Results: Data from the 2 trials showed that there was a 62% pain reduction with laser pretreatment plus lidocaine compared with laser pretreatment plus placebo, and a 61% pain reduction with laser pretreatment plus lidocaine, compared with lidocaine alone. The decrease in pain in both trials was statistically significant (PϽ.001). Adverse events reported 48 hours after treatment were few and mild. Conclusion:Treatment with the Er:YAG laser followed by lidocaine cream is a safe, effective, and efficient means of inducing skin anesthesia that significantly reduces the pain of hypodermic needle insertion.

Fractional CO2 laser‐assisted drug delivery

“…Conventional Er:YAG laser ablation of stratum corneum and superficial epidermis enhanced PpIX accumulation in murine superficial skin layers and subcutaneous tumors as well as ALA penetration of in vivo porcine skin [19,20]. In addition, pre-treatment with conventional erbium:YAG laser improved the anesthetic efficacy of topically applied lidocaine [18,21]. Donnelly et al [36] evaluated microneedle-mediated intradermal delivery of 5-ALA, which enhanced ALA delivery to superficial regions of excised porcine skin, but not to deeper skin layers.…”

“…Erbium lasers in particular have been used for laser-assisted cutaneous drug delivery [18][19][20][21], but the potential for deep AFR-assisted drug delivery has not been studied. Whole skin in vitro is a well-accepted standard for measuring drug uptake by passive diffusion.…”

Dermal and Transdermal Drug Delivery Systems: Current and Future Prospects

“…As such a handheld portable laser device has been developed by Norwood Abbey Ltd. (Victoria, Australia). In a study involving human volunteers (Baron et al 2003), the Norwood Abbey laser device reduced the onset of action of lidocaine to 3-5 min, while 60 min were required to attain a similar effect in the control group. The Norwood Abbey system has been approved by the United States and Australian regulatory bodies for the administration of a topically applied anesthetic.…”

Physical Approaches to Penetration Enhancement

“…A hand-held portable laser device has been developed by Norwood Abbey Ltd (Victoria, Australia). In a study involving human volunteers 56 , the Norwood Abbey laser device was found to reduce the onset of action of lidocaine to 3-5 min, whilst 60 min was required to attain a similar effect in the control group. The Norwood Abbey system has been approved by the US and Australian regulatory bodies for the administration of a topically applied anesthetic.…”