Providing pain relief for laser resurfacing: Effectiveness of the CoolAnalgesia© device

Laser resurfacing is a painful procedure, and is therefore usually carried out under general anaesthetic or local anaesthetic with sedation. However, the small but significant risk of adverse events from either of these methods has resulted in an effort to develop other methods of controlling the pain associated with the use of lasers. This trial describes of the use of a cooling device (the CoolAnalgesia device) with a carbon dioxide laser. The only anaesthetic used was a eutectic mixture of lidocaine anaesthetic (EMLA) applied as a cream to the face at least 60 min prior to the procedure. Twenty consecutive patients attending two laser centres for facial resurfacing were recruited. Each patient was asked to assess the level of pain on a visual analogue scale from 1-10 every 2 min during lasering. Only one of the patients had a mean pain score for the duration of the treatment of above five, four patients recorded a pain score of above five at some stage during their treatment, but none requested that the treatment be stopped. It would appear that the CoolAnalgesia device in combination with EMLA cream provides a level of anaesthesia sufficient to allow laser resurfacing without the use of local anaesthetic injections or intra-venous agents.

Functional outcomes following surgical repair of wrist extensor tendons

The long term results following the repair of open injuries to extensors carpi radialis longus and brevis and extensor carpi ulnaris have not previously been reported. A retrospective case note review was performed and patients were called back for assessment following surgical repair. Grip strength and pinch strength were reduced by 9.9% (p=0.017) and 11.5% (p=0.049). Wrist movement was also reduced. This demonstrates that the division of these tendons should not be regarded as trivial as they may have long-term adverse effects on wrist function. Information gained from this study may be beneficial in patient education at the time of injury and may provide useful information when preparing medico legal reports.