1
|
Does Topical Anesthesia Alter the Outcomes of Vascular Laser Procedures? Review of Vasodynamic Effects and Clinical Outcomes Data. Dermatol Surg 2023; 49:266-271. [PMID: 36716423 DOI: 10.1097/dss.0000000000003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Topical anesthesia has vasodynamic effects within the skin and therefore has the potential to change the presence of hemoglobin as a chromophore before intense pulsed light (IPL) and vascular laser treatments. It is unclear whether this is clinically relevant. Global consensus on the use of topical anesthetics in this context is lacking. OBJECTIVE Review the effects of topical anesthetics on the skin microvasculature and the clinical implications of such effects on vascular treatments. METHODS PubMed and Medline searches were performed to identify studies examining the vasodynamic effects of topical anesthesia on skin and evaluating differences in efficacy of IPL and vascular laser treatments with or without topical anesthetic use. RESULTS Published studies reveal variable effects of different topical anesthetic agents on skin microvasculature. Only 3 controlled studies that directly examined the effect of topical anesthesia on clinical outcomes for pulsed dye laser (PDL) treatment of vascular conditions were identified. They did not support a difference in clinical outcomes with or without the use of topical anesthesia before PDL treatment. CONCLUSION Although topical anesthetic agents have vasodynamic effects within the skin, there is currently insufficient evidence to advise against their use before light and laser-based vascular treatments.
Collapse
|
2
|
Henni S, Hersant J, Loufrani L, Duval G, Humeau-Heurtier A, Riou J, Abraham P. Painless local pressure application to test microvascular reactivity to ischemia. Microvasc Res 2018; 122:13-21. [PMID: 30399363 DOI: 10.1016/j.mvr.2018.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Forearm cutaneous blood flux (CBF) measurement with post-occlusive reactive hyperemia (PORH) is uncomfortable and may not be devoid of risks. We aimed to investigate post-compression reactive hyperemia (PCRH) with a custom-made indenter that was designed to be easily used routinely by inexperienced observers. METHODS Medical students evaluated PCRH with 1- to 4-min pressure applications of 16 to 34 kPa and PORH with 3-min forearm cuff occlusion using laser speckle contrast imaging in 15 healthy volunteers. Participants were asked to quantify their discomfort with a visual analogue scale (VAS) of 10 cm. Total ischemia (ISCH) was quantified by the product of CBF during ischemia and ischemia duration (min). We subtracted the CBF changes in the skin from a reference ipsilateral (PCRH) or contralateral (PORH) non-stimulated area. RESULTS The average VAS was 1.0 for PCRH vs. 6.0 for PORH (p < 0.001). A strong linear relationship between ISCH and peak PCRH (r2 = 0.915, p < 0.001) was noted. Peak PORH values (63.9 laser perfusion units (LPU)) were significantly lower than all values of the 3-min PCRH (72.6 LPU), including the one obtained with 16 kPa. CONCLUSION Inexperienced observers could test microvascular reactivity with PCRH without inducing the discomfort that is typically experienced with PORH. Further, PCRH elicits a higher peak response to ischemia compared with PORH. This extremely simple method could influence a broad spectrum of routine cutaneous microcirculation investigations, especially when a painful approach is particularly inadequate or if the patient is fragile. CLINICAL TRIAL REGISTRATION NCT02861924.
Collapse
Affiliation(s)
- Samir Henni
- Vascular Medicine, University Hospital of Angers, France; MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Jeanne Hersant
- Vascular Medicine, University Hospital of Angers, France; MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Laurent Loufrani
- MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France
| | - Guillaume Duval
- Department of Gerontology, University Hospital of Angers, France
| | - Anne Humeau-Heurtier
- Université Angers, LARIS - Laboratoire Angevin de Recherche en Ingénierie des Systèmes, Angers, France
| | -
- Vascular Medicine, University Hospital of Angers, France
| | - Jeremie Riou
- UMR Inserm 1066 - CNRS 6021, Faculté de Médecine, Angers, France
| | - Pierre Abraham
- MitoVasc Institute, UMR CNRS 6015 - INSERM U 1083, Faculté de Médecine, Angers, France; Sports Medicine, University Hospital of Angers, France.
| | | |
Collapse
|
3
|
Purcell A, Buckley T, Fethney J, King J, Moyle W, Marshall AP. The Effectiveness of EMLA as a Primary Dressing on Painful Chronic Leg Ulcers: Effects on Wound Healing and Health-Related Quality of Life. INT J LOW EXTR WOUND 2017; 16:163-172. [PMID: 28836470 DOI: 10.1177/1534734617726678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the effect of EMLA 5% cream applied to painful chronic leg ulcers (CLUs) as a primary dressing on wound healing and health-related quality of life (HRQoL). A pilot, parallel-group, nonblinded, randomized controlled trial was conducted in 6 community nursing procedure clinics in New South Wales, Australia. A total of 60 participants with painful CLUs of varied etiology were randomly assigned to the intervention (EMLA daily for 4 weeks as a primary dressing, followed by usual care) or usual care only. Wound size and HRQoL were measured at baseline, end of the intervention period (week 4), and week 12. At baseline, wound sizes were similar for both the intervention and control groups. During the intervention period, there was no significant difference in wound sizes between groups (intervention group: median (cm2) = 2.4, IQR = 1.3-12.7; control group: median (cm2) = 5.0, IQR = 2.5-9.9; P = .05). Mean HRQoL scores for all subscales at baseline and weeks 4 and 12 were similar between groups except for Wellbeing, which was significantly higher in the intervention group at the end of the 4-week intervention period (intervention group: mean = 52.41, SD = 24.50; control group: mean = 38.15, SD = 21.25; P = .03; d = 0.62). The trial findings suggest that daily applications of EMLA as a primary dressing do not inhibit wound healing and may improve patient well-being. Studies with larger samples are required to more comprehensively evaluate the impact of this treatment on wound healing and HRQoL.
Collapse
Affiliation(s)
- Anne Purcell
- 1 Griffith University, QLD, Australia.,2 Central Coast Local Health District, NSW, Australia
| | | | | | - Jennie King
- 2 Central Coast Local Health District, NSW, Australia.,3 University of Sydney, NSW, Australia
| | | | - Andrea P Marshall
- 1 Griffith University, QLD, Australia.,4 Gold Coast Health, QLD, Australia
| |
Collapse
|
4
|
Cozzi G, Borrometi F, Benini F, Neri E, Rusalen F, Celentano L, Zanon D, Schreiber S, Ronfani L, Barbi E. First-time success with needle procedures was higher with a warm lidocaine and tetracaine patch than an eutectic mixture of lidocaine and prilocaine cream. Acta Paediatr 2017; 106:773-778. [PMID: 28130888 DOI: 10.1111/apa.13764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/08/2016] [Accepted: 01/24/2017] [Indexed: 01/30/2023]
Abstract
AIM More than 50% of children report apian during venepuncture or intravenous cannulation and using local anaesthetics before needle procedures can lead to different success rates. This study examined how many needle procedures were successful at the first attempt when children received either a warm lidocaine and tetracaine patch or an eutectic mixture of lidocaine and prilocaine (EMLA) cream. METHODS We conducted this multicentre randomised controlled trial at three tertiary-level children's hospitals in Italy in 2015. Children aged three to 10 years were enrolled in an emergency department, paediatric day hospital and paediatric ward and randomly allocated to receive a warm lidocaine and tetracaine patch or EMLA cream. The primary outcome was the success rate at the first attempt. RESULTS The analysis included 172 children who received a warm lidocaine and tetracaine patch and 167 who received an EMLA cream. The needle procedure was successful at the first attempt in 158 children (92.4%) who received the warm patch and in 142 children (85.0%) who received the cream (p = 0.03). The pain scores were similar in both groups. CONCLUSION This study showed that the first-time needle procedure success was 7.4% higher in children receiving a warm lidocaine and tetracaine patch than EMLA cream.
Collapse
Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Fabio Borrometi
- Pediatric Pain Service and Palliative Care; Department of Oncology; Pausilipon Hospital; AORN Santobono Pausilipon; Naples Italy
| | - Franca Benini
- Department of Women's and Children's Health; University of Padua; Padua Italy
| | - Elena Neri
- Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Francesca Rusalen
- Department of Women's and Children's Health; University of Padua; Padua Italy
| | - Loredana Celentano
- Pediatric Pain Service and Palliative Care; Department of Oncology; Pausilipon Hospital; AORN Santobono Pausilipon; Naples Italy
| | - Davide Zanon
- Pharmacy and Clinical Pharmacology Unit; Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Silvana Schreiber
- Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Luca Ronfani
- Clinical Epidemiology and Health Services Research Unit; Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health; IRCCS Burlo Garofolo; Trieste Italy
| |
Collapse
|
5
|
Tollan CJ, MacLaren W, Mackay IR. Topical anaesthetic effects on skin vasculature with potential implications for laser treatment. Lasers Med Sci 2016; 31:611-7. [PMID: 26861976 DOI: 10.1007/s10103-016-1872-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
Abstract
Laser treatment of vascular lesions is affected by parameters including the diameter and depth of the vessels and flow within the vessels. Topical anaesthetics are in common use prior to laser treatment but may have effects on vessel parameters and, subsequently, the efficacy of laser treatment. Eleven patients with capillary vascular malformations were investigated for vessel diameter before and after elective application of a topical anaesthetic, Eutectic Mixture of Local Anaesthetics (EMLA) (AstraZeneca) or Ametop (S&N Health), prior to pulsed dye laser treatment. EMLA contains 2.5% lidocaine ad 2.5% prilocaine, and Ametop gel contains 4% tetracaine. Patients' capillary malformations were assessed using confocal laser scanning microscopy (CLSM) (Vivascope 1500 Mavig GmbH, Munich). Six of the 11 patients recruited had EMLA topical anaesthetic, and five had Ametop. Four hundred twenty-one diameters were measured. The mean vessel diameter was 50.87 μm. Previous laser treatments undergone by each patient were noted to exclude this as a confounding variable, and no significant difference was found between topical anaesthetic groups. Statistical calculations were made using GenStat and Minitab. There is no evidence that Ametop affects mean diameter (p value is 0.361). EMLA reduces the mean diameter of vessels (p = 0.002), with a 27% reduction in post-EMLA diameter. This study demonstrates that the use of EMLA cream has a statistically significant reduction vessel diameter. As it is known that vessel diameter is important for the response of laser treatment, the use of EMLA may affect outcome.
Collapse
Affiliation(s)
| | - William MacLaren
- Department of Statistics, Department of Statistics, Glasgow Caledonian University, Glasgow, G4 OBA, UK
| | - Iain R Mackay
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, G4 OSF, UK
| |
Collapse
|
6
|
Metzler-Wilson K, Wilson TE. Topical anaesthesia does not affect cutaneous vasomotor or sudomotor responses in human skin. ACTA ACUST UNITED AC 2013; 33:25-33. [PMID: 23663206 DOI: 10.1111/aap.12007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/16/2013] [Accepted: 03/08/2013] [Indexed: 12/31/2022]
Abstract
(1) The effects of local sensory blockade (topical anaesthesia) on eccrine sweat glands and cutaneous circulation are not well understood. This study aimed to determine whether topical lidocaine/prilocaine alters eccrine sweat gland and cutaneous blood vessel responses. (2) Sweating (capacitance hygrometry) was induced via forearm intradermal microdialysis of five acetylcholine (ACh) doses (1 × 10(-4) to 1 × 10(0) m, 10-fold increments) in control and treated forearm sites in six healthy subjects. Nitric oxide-mediated vasodilatory (sodium nitroprusside) and adrenergic vasoconstrictor (noradrenaline) agonists were iontophoresed in lidocaine/prilocaine-treated and control forearm skin in nine healthy subjects during blood flow assessment (laser Doppler flowmetry, expressed as% from baseline cutaneous vascular conductance; CVC; flux/mean arterial pressure). (3) Non-linear regression curve fitting identified no change in the ED50 of ACh-induced sweating after sensory blockade (-1.42 ± 0.23 logM) compared to control (-1.27 ± 0.23 logM; P > .05) or in Emax (0.43 ± 0.08 with, 0.53 ± 0.16 mg cm(-2) min(-1) without lidocaine/prilocaine; P > .05). Sensory blockade did not alter the vasodilator response to sodium nitroprusside (1280 ± 548% change from baseline CVC with, 1204 ± 247% without lidocaine/prilocaine) or vasoconstrictor response to noradrenaline (-14 ± 4% change from baseline CVC with, -22 ± 14% without lidocaine/prilocaine; P > 0.05). (4) Cutaneous sensory blockade does not appear to alter nitric oxide-mediated vasodilation, adrenergic vasoconstriction, or cholinergic eccrine sweating dose-response sensitivity or responsiveness to maximal dose. Thus, lidocaine/prilocaine treatment should not affect sweat gland function or have blood flow implications for subsequent research protocols or clinical procedures.
Collapse
Affiliation(s)
- K Metzler-Wilson
- Ohio Musculoskeletal and Neurological Institute, Irvine Hall, Ohio University, Athens, OH, 45701, USA; Department of Physical Therapy, Lebanon Valley College, 101 N College Ave, Annville, PA, 17003, USA
| | | |
Collapse
|
7
|
Ruetzler K, Sima B, Mayer L, Golescu A, Dunkler D, Jaeger W, Hoeferl M, You J, Sessler D, Grubhofer G, Hutschala D. Lidocaine/tetracaine patch (Rapydan) for topical anaesthesia before arterial access: a double-blind, randomized trial. Br J Anaesth 2012; 109:790-6. [DOI: 10.1093/bja/aes254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
8
|
Purcell A, Marshall A, King J, Buckley T. Eutectic mixture of local anaesthetics (EMLA) 5% cream as a primary dressing on a painful lower leg ulcer. J Wound Care 2012; 21:309-10, 312, 314. [PMID: 22886329 DOI: 10.12968/jowc.2012.21.7.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Patients living with chronic leg ulceration may frequently experience moderate to severe wound-related pain, which may not be alleviated by oral analgesics alone. Poorly controlled leg ulcer pain can prevent timely and effective wound management strategies being implemented, and increase wound healing times. Furthermore, patients with poorly controlled leg ulcer pain can experience continuous pain, which significantly affects quality of life. This case report introduces an innovative way of using the eutectic mixture of local anaesthetics (EMLA) 5% cream to reduce wound-related pain, reduce oral analgesic intake, and improve health-related quality of life for a patient with a painful, chronic lower leg ulcer.
Collapse
Affiliation(s)
- A Purcell
- Central Coast Community Nursing Service, Central Coast Local Health District, Australia.
| | | | | | | |
Collapse
|
9
|
Ravishankar N, Elliot SC, Beardow Z, Mallick A. A comparison of Rapydan®patch and Ametop®gel for venous cannulation*. Anaesthesia 2012; 67:367-70. [DOI: 10.1111/j.1365-2044.2011.07000.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
10
|
New formulations of local anaesthetics-part I. Anesthesiol Res Pract 2011; 2012:546409. [PMID: 22190922 PMCID: PMC3235423 DOI: 10.1155/2012/546409] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 09/14/2011] [Accepted: 09/14/2011] [Indexed: 01/29/2023] Open
Abstract
Part 1 comments on the types of local anaesthetics (LAs); it provides a better understanding of the mechanisms of action of LAs, and their pharmacokinetics and toxicity. It reviews the newer LAs such as levobupivacaine, ropivacaine, and articaine, and examines the newer structurally different LAs. The addition of adjuvants such as adrenaline, bicarbonate, clonidine, and corticosteroids is explored. Comment is made on the delivery of topical LAs via bioadhesive plasters and gels and controlled-release local anaesthetic matrices. Encapulation matrices such as liposomes, microemulsions, microspheres and nanospheres, hydrogels and liquid polymers are discussed as well. New innovations pertaining to LA formulations have indeed led to prolonged action and to novel delivery approaches.
Collapse
|
11
|
Abstract
There has been an increasing focus on development of new routes of drug administration to provide tailored treatments for patients, without decreasing efficacy of analgesia, in proportion to the progression of the knowledge of pain mechanisms. While acute pain acts as an alarm, chronic pain is a syndrome requiring meticulous selection of analgesic drugs of high bioavailability for long-term use. Such criteria are challenges that topical medications aim to overcome, allowing progressive delivery of active component, maintaining stable plasma levels, with a good safety profile. This review presents recent findings regarding topical formulations of the most widely used drugs for pain treatment, such as nonsteroidal anti-inflammatory agents, anesthetics, and capsaicin, and the role of physical agents as delivery enhancers (phonophoresis and iontophoresis). Although the number of topical agents is limited for use in peripheral conditions, increasing evidence supports the efficacy of these preparations in blocking nociceptive and neuropathic pain. Patient adherence to medical treatment is also a challenge, especially in chronic painful conditions. It is known that reduction of treatment complexity and pill burden are good strategies to increase patient compliance, as discussed here. However, the role of topical presentations, when compared to traditional routes, has not yet been fully explored and thus remains unclear.
Collapse
Affiliation(s)
- Liliana L Jorge
- Lucy Montoro Institute of Rehabilitation, São Paulo, São Paulo, Brazil
| | | | | |
Collapse
|
12
|
Mahé G, Rousseau P, Durand S, Bricq S, Leftheriotis G, Abraham P. Laser speckle contrast imaging accurately measures blood flow over moving skin surfaces. Microvasc Res 2010; 81:183-8. [PMID: 21156183 DOI: 10.1016/j.mvr.2010.11.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 12/01/2022]
Abstract
Cutaneous blood flow (CBF) can be assessed non-invasively with lasers. Unfortunately, movement artefacts in the laser skin signal (LS(sk)) might sometimes compromise the interpretation of the data. To date, no method is available to remove movement artefacts point-by-point. Using a laser speckle contrast imager, we simultaneously recorded LS(sk) and the signal backscattered from an adjacent opaque surface (LS(os)). The completion of a first protocol allowed a definition of a simple equation to calculate the CBF from movement artefact-affected traces of LS(sk) and LS(os). We then recorded LS(sk) and LS(os) before, during and for 5 min after the tourniquet ischemia, both when subjects (n=8) were immobile or submitted to external passive movements of random intensity throughout the test. The typical post-occlusive reactive hyperemia trace was not identifiable within the LS(sk) recordings, with LS(sk) being 2 to 3 times higher during movements than in the immobile situation. After the calculation of CBF, traces in the immobile versus movement conditions were comparable, with the "r" cross-correlation coefficient being 0.930+/-0.010. Our method might facilitate future investigations in microvascular physiology and pathophysiology, specifically in subjects who have frequent or continuous involuntary movements.
Collapse
Affiliation(s)
- Guillaume Mahé
- Laboratory of Vascular Investigations, University Hospital of Angers, France
| | | | | | | | | | | |
Collapse
|