Singer Adam J, Regev Ran, Weeks Robert, Tlockowski Debbie S
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY 11794-8350M, USA.
Acad Emerg Med. 2005 Sep;12(9):804-7. doi: 10.1197/j.aem.2005.04.011.
Intravenous cannulation is common and painful. Absorption of topical anesthetics is limited by the stratum corneum, the outermost layer of the epidermis. A single pulse of an erbium:yttrium-aluminum-garnet (Er:YAG) laser irradiation can remove an area of the stratum corneum, leading to enhanced uptake of topical agents, such as lidocaine, while leaving the rest of the epidermis intact.
The authors hypothesized that pretreatment of the skin with laser-assisted anesthesia would reduce the pain of venous cannulation.
This was a blinded, randomized, controlled clinical trial. Subjects were 30 healthy adult volunteers. Standardized venous cannulation was performed on the dorsum of both of each subject's hands. In the study hand, the area over the target vein was pretreated with a lightweight, portable Er:YAG unit, with a fluence of 3.5 J/cm(2), a pulse width of 600 microseconds, and a spot diameter of 6 mm. Lidocaine 4% cream was applied to the area. After 5 minutes, the cream was wiped off and a nurse inserted an intravenous (IV) catheter and verified placement. In the control hand, a sham laser was used. Pain of laser application and pain of IV cannulation were recorded on a validated 100-mm visual analog scale (VAS) marked "most pain" at the high end. The presence of burns, infection, and scarring at one week and at three months after the study was also noted. The levels of pain of cannulation were compared using a paired t-test.
Mean subject age was 32 years; 43% were female. The mean pain of cannulation after laser-assisted lidocaine application (13 mm, 95% CI = 8 to 19) was significantly less than after application of sham laser (29 mm, 95% CI = 22 to 36; mean difference, 15 mm, 95% CI = 6 to 24). No subject had persistent erythema or scarring.
Pretreatment of the skin with a laser device followed by a 5-minute topical lidocaine application reduces the pain of IV cannulation in volunteers.
静脉穿刺很常见且会引起疼痛。局部麻醉剂的吸收受到表皮最外层角质层的限制。单次脉冲掺铒钇铝石榴石（Er:YAG）激光照射可去除角质层的一部分区域，从而增强局部用药（如利多卡因）的吸收，同时使表皮的其余部分保持完整。
作者推测激光辅助麻醉预处理皮肤可减轻静脉穿刺的疼痛。
这是一项双盲、随机、对照临床试验。受试者为30名健康成年志愿者。在每位受试者双手的背部进行标准化静脉穿刺。在研究侧手部，使用轻便的便携式Er:YAG设备对目标静脉上方区域进行预处理，能量密度为3.5 J/cm²，脉冲宽度为600微秒，光斑直径为6 mm。将4%利多卡因乳膏涂抹于该区域。5分钟后，擦去乳膏，由护士插入静脉（IV）导管并确认导管位置。在对照侧手部，使用假激光。在经过验证的100毫米视觉模拟量表（VAS）上记录激光照射的疼痛和静脉穿刺的疼痛，量表高端标记为“最痛”。还记录了研究后1周和3个月时烧伤、感染和瘢痕形成的情况。使用配对t检验比较穿刺疼痛水平。
受试者平均年龄为32岁；43%为女性。激光辅助应用利多卡因后穿刺的平均疼痛程度（13 mm，95%CI = 8至19）明显低于应用假激光后的疼痛程度（29 mm，95%CI = 22至36；平均差值，15 mm，95%CI = 6至24）。没有受试者出现持续性红斑或瘢痕形成。
使用激光设备预处理皮肤，随后局部应用5分钟利多卡因，可减轻志愿者静脉穿刺的疼痛。
