Abstract 13


Journal of Dermatologic Surgery and Oncology, 18:287-294, 1992.

Iontophoresis of Lidocaine for Anesthesia During Pulsed Dye Laser Treatment of Port-Wine Stains

Charles D. Kennard, MD, and Duane C. Whitaker, MD
Department of Dermatology
University of Iowa Hospital and Clinics, Iowa City, Iowa
ABSTRACT

Port-wine stains way be effectively ablated using the pulsed dye laser emitting at a wavelength of 577 or 585 nm. However, discomfort of this therapy may be severe enough to require reduction of treatment duration thereby increasing the need for repeat sessions. Currently available methods of anesthesia or sedation for pulsed dye laser therapy have drawbacks to their use. We performed a prospective double-blind, placebo-controlled evaluation of the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 for local anesthesia during pulsed dye laser ablation of port-wine stains. Eleven patients with port-wine stains completed the initial phase of the study. Pain scale evaluation by patients demonstrated significant decreases in the discomfort of pulsed dye laser impulses by the iontophoresis of lidocaine HCl 4% and lidocaine HCl 4% with epinephrine 1:50,000 (P<.0001), with no significant difference between these treatments. Follow-up evaluation suggests that iontophoresis has no detrimental effect on pulsed dye laser ablation of port-wine stains, despite significant decreases in perfusion, as measured by laser Doppler velocimetry, of port-wine stain areas receiving iontophoresis of lidocaine with epinephrine. Iontophoresis of lidocaine HCl 4% with or without epinephrine is a safe and effective method of local anesthesia for pulsed dye laser therapy.
DISCUSSION

?The advantages of this therapy over currently available methods of anesthesia for pulsed dye laser therapy are its convenience, lack of discomfort of application, and lack of side effects.

?...10 out of 11 of our patients felt the process was 'worthwhile' or 'very worthwhile'. The medication-delivery electrode conformed to the complex contours of the nose and lips without difficulty...several of out patients requested the use of the active medication for iontophoresis before further pulsed dye laser therapy.

?Physician time requirements need not be increased by the use of iontophoresis.


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