Abstract 12


Journal of the American Academy of Dermatology, 19:869-875, 1998.

Painless Cauterization of Spider Veins with the Use of Iontophoretic Local Anesthesia

John L. Bezzant, MD, Robert L. Stephen, MD,
Tomasz J. Petelenz, PhD, and Stephen C. Jacobsen, PhD
Division of Dermatology, Institute of Biomedical Engineering, and
The Center for Engineering Design, University of Utah, Salt Lake City, Utah
ABSTRACT

Treatment of small vascular abnormalities of the skin is painful, and injections of local anesthetic agents distort the opening field. Iontophoresis of salt-free, 4% lidocaine, with and without epinephrine, delivered to the skin from a receptacle with a semipermeable membrane, and with the use of a current-controlled electrical system, resulted in effective anesthesia of the skin for cauterization of ?spider veins. Fourteen subjects received 32 treatments. Sixteen paired areas of spider veins anesthetized with iontophoresis of lidocaine and with lidocaine plus epinephrine 1/50,000. The duration of anesthesia with lidocaine averaged 14 minutes; relief of pain was complete in 9/16 treatments, adequate in 6/16, and inadequate in 1/16. Lidocaine plus epinephrine supplied anesthesia for 56 minutes; relief of pain with the use of selected local anesthetics and iontophoretic equipment provides adequate conditions for cauterization of spider veins, a procedure poorly served by conventional local anesthesia.
DISCUSSION

?...4% lidocaine with epinephrine 1/50,000 (0.06 mg) [was] prepared by injecting 0.1 mL of epinephrine 1/1,000 into a 5 mL vial of lidocaine.

?The advantages of iontophoresis are (1) it is painless, (2) there is no tissue distortion, and (3) there is adequate local, and little systemic, concentration of the drug.

?The results achieved with lidocaine and epinephrine 1/50,000 were superior in every respect.

?The addition of ... epinephrine to the local anesthetic agent enhanced the therapist's delineation of treatment sites, increased the duration of the anesthesia, and eliminated the otherwise inevitable edematous papules caused by transcutaneous cauterization procedures.


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