From the Guidelines
Topical anesthesia is recommended as a first-line method of anesthesia for nonablative laser treatments, including laser coagulation, according to the guidelines for the use of local anesthesia in office-based dermatologic surgery 1. When considering anesthesia for laser coagulation, it's essential to prioritize the patient's comfort and safety. The guidelines suggest that topical agents, such as topical lidocaine, are preferred for nonablative laser treatments, including laser coagulation.
- The use of topical anesthetic agents can help lessen the pain of injection and reduce the dose of infiltration anesthesia needed for larger procedures 1.
- For more extensive procedures, the combination of topical and infiltration anesthesia should be considered as an alternate to sedation or general anesthesia in pediatric patients 1.
- Infiltrative anesthesia is safe and recommended for office-based dermatologic procedures, including nonablative laser, and may be combined with other forms of local anesthesia for larger or more complex cutaneous procedures 1.
- The maximum safe dose of local infiltrated anesthesia is unknown, but guidelines suggest that no more than 4.5 mg/kg of lidocaine and 7.0 mg/kg of lidocaine with epinephrine should be administered in a single treatment for adults, and no more than 1.5-2.0 mg/kg of lidocaine and 3.0-4.5 mg/kg of lidocaine with epinephrine for children 1. It's crucial to consider the patient's individual needs and medical history when selecting an anesthetic approach for laser coagulation.
- Topical lidocaine is safe for use on pregnant or nursing women, but there is insufficient evidence to recommend use of other topical anesthetics 1.
- Elective procedures and those not of urgent medical necessity requiring topical lidocaine in pregnant women should be postponed until after delivery, and procedures of urgent medical necessity should be delayed until at least the second trimester when possible 1.
From the Research
Anaesthesia for Laser Coagulation
- The use of local anaesthesia for laser coagulation has been studied in various settings, including ophthalmology and emergency medicine 2, 3, 4.
- A study comparing lidocaine and bupivacaine for peribulbar anesthesia found that lidocaine plus ropivacaine provided better akinesia and similar analgesia compared to lidocaine plus bupivacaine 2.
- Subconjunctival lidocaine has been shown to reduce the incidence of pain in patients undergoing laser retinopexy or panretinal photocoagulation 3.
- In a network meta-analysis, the risk of transient neurological symptoms (TNS) was lower with bupivacaine, levobupivacaine, prilocaine, procaine, and ropivacaine compared to lidocaine 5.
- A clinical comparison of lidocaine and bupivacaine found that bupivacaine provided longer-lasting anesthesia and reduced pain after repair of lacerations 4.
- For the percutaneous laser treatment of twin-twin transfusion syndrome, local anesthesia/conscious sedation was found to be the safest anesthetic technique, with fewer maternal-fetal hemodynamic fluctuations and less intraamniotic bleeding compared to general anesthesia or total intravenous anesthesia 6.