Use of a Laser Device to Enhance Anesthesia Prior to Intravenous Cannulation in Emergency Department Patients

Weeks, Ryan

doi:10.1197/j.aem.2005.03.440

Cited by 2 publications

(4 citation statements)

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“…A single pulse of Er:YAG laser irradiation can remove an area of the stratum corneum, leading to enhanced uptake of topical agents such as lidocaine and epinephrine. 9 Recent studies have demonstrated that pretreatment of the skin with this laser device followed by a five-minute application of 4% liposomal lidocaine is an effective means of reducing the pain of venous cannulation in both patients 13 and volunteers. 12 The results of the current study demonstrate that laser irradiation of porcine skin results in temporary damage to the epidermis that is similar in histomorphologic appearance to a first-degree burn.…”

Section: Discussionmentioning

confidence: 99%

“…21 Small studies in both human volunteers and patients have demonstrated that laser-assisted anesthesia before intravenous cannulation is safe and effective. 12,13 While the cost of the laser device is approximately $2,000, the cost per patient is estimated at approximately $5, which is not prohibitive and is sometimes even reimbursable. The results of our study further support the clinical studies suggesting that clinical use of the laser device is safe and does not result in scarring or infection.…”

Section: Discussionmentioning

confidence: 99%

“…This device has been used in clinical trials at our center. 12,13 All wounds were covered with dry nonadherent gauze (Telfa; Kendall Healthcare Products Co., Mansfield, MA). The wounds were then covered with a gauze bandage roll (Conform; Kendall Healthcare Products Co.) and an adhesive elastic bandage (Elastoplast; Beiersdorf-Jobst, Inc., Rutherford College, NC).…”

Section: Methodsmentioning

confidence: 99%

“…9 Several clinical trials evaluating a handheld Er:YAG laser device have demonstrated the ability of laser-assisted anesthesia to reduce the pain associated with intramuscular needle insertion 10,11 and intravenous cannulation. 12,13 However, because the laser ablates the stratum corneum, there are concerns that the associated cutaneous injury may result in adverse events such as infection and scarring. Furthermore, with the increased use of long-term venous catheters in immunocompromised patients with cancer, there is concern that removal of the stratum corneum might expose these patients to line infections and sepsis.…”

mentioning

confidence: 99%

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Histologic Effects of Laser‐assisted Topical Anesthesia in a Porcine Model

Singer

McClain

et al. 2005

Academic Emergency Medicine

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Objectives: A handheld laser device that removes the stratum corneum, the major barrier to transdermal absorption, has recently been approved to assist with topical anesthesia before painful procedures such as intravenous cannulation. The authors assessed the cutaneous histomorphologic effects of the laser device and the ability of the laser-treated skin to resist infection in a porcine model. Methods: This was a blinded, randomized animal experiment using isoflurane-anesthetized young domestic pigs. The ventral surface of the animals was irradiated multiple times with a lightweight, portable erbium yttrium-aluminum-garnet unit or a sham laser. One third of the wounds were inoculated with a Staphylococcus aureus suspension. The treated areas were then covered with a dry dressing, and full-thickness biopsy specimens of the treated areas were obtained immediately after treatment and at three, seven, ten, and 14 days for blinded histopathologic evaluation using hematoxylin and eosin staining and electron microscopy. Quantitative bacterial counts were obtained at three days in wounds exposed to bacteria. Main outcomes were quantitative bacterial counts, presence of cellular necrosis, epidermal integrity, and dermal scarring. Data analysis was conducted with descriptive statistics. Results: Laser irradiation resulted in immediate disruption of the cornified layer of the skin and necrosis of the stratum spinosum in all treated areas. There were also focal areas of vacuolar alteration of the basal one third of the epidermis. There was no evidence of any damage to the basement membrane or the underlying dermis. At three days, the epidermis had healed and there was evidence of epidermal hyperplasia and hyperkeratosis that was completely resolved by 14 days. There were no infections and no scarring. Sham laser had no histomorphologic effects on the skin. There was no bacterial growth from all sham laser-treated wounds challenged with bacteria. Three of 20 (15%; 95% confidence interval ¼ 0% to 31%) laser-irradiated wounds that were challenged with bacteria grew between 280,000 and 1,600,000 colony-forming units/g. Conclusions:Laser irradiation results in ablation of the stratum corneum and a superficial burn to the epidermis that heals by three to 14 days without any scarring or infection in pigs. Challenging laser-irradiated cutaneous wounds with a large bacterial inoculum resulted in bacterial growth in a minority of wounds.

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Section: Discussionmentioning

confidence: 99%