Plastic Surgery Department, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
Aesthet Surg J. 2013 Aug 1;33(6):854-61. doi: 10.1177/1090820X13496248.
Injectable forms of anesthesia for nonsurgical facial rejuvenation, although efficacious, are uncomfortable for the patient. Preclinical studies have demonstrated that laser pretreatment at low energies enhances absorption of topical lidocaine.
The authors assess the safety and efficacy of laser-assisted transdermal delivery of topical anesthetic.
Ten patients were split into 2 groups (A and B). All patients received 15 g of BLT (20% benzocaine, 6% lidocaine, and 4% tetracaine triple anesthetic cream) for 20 minutes with no occlusion. Then the cream was removed and the first blood draw taken. Group A patients were pretreated with the full ablative laser and group B patients with a fractional ablative laser to the full face. A further 15 g BLT was applied for another 20 minutes. Group A patients then underwent full ablative laser treatment, and group B received fractionated ablative laser treatment. Blood draws were taken at 60, 90, 120, 180, and 240 minutes after the initial topical anesthetic application, and the serum was analyzed for lidocaine and monoethylglycinexylidide (MEGX) levels. Patients were asked to rate the pain felt at intervals during the procedure.
No patient required supplemental nerve blocks. Pain scores were equivalent at the end of the first pass for both groups (P = .436). Group A patients had significantly lower pain scores at the start of the second laser treatment (P = .045), but pain scores became equivalent by the end (P = .323). Combined serum lidocaine and MEGX levels were significantly higher in group A patients up to 90 minutes (peak average of 0.61 µg/mL for group A and 0.533 µg/mL for group B; P = .0253), which corresponded to greater initial analgesic effect.
Data from this study demonstrate that topical anesthetic for facial rejuvenation can be enhanced with laser pretreatment while maintaining safe blood serum levels. Further studies should examine optimal application amount and time to allow safe multipass facial rejuvenation without the need for invasive nerve blocks.
非手术面部年轻化的注射用麻醉剂虽然有效，但对患者来说并不舒适。临床前研究表明，低能量激光预处理可增强局部利多卡因的吸收。
作者评估激光辅助经皮递送局部麻醉剂的安全性和有效性。
10 名患者分为 2 组（A 组和 B 组）。所有患者均接受 15 g 的 BLT（20%苯佐卡因、6%利多卡因和 4%四卡因三重麻醉乳膏），无闭塞，共 20 分钟。然后去除乳膏并抽取第一份血样。A 组患者接受全消融激光预处理，B 组患者接受全脸分段消融激光预处理。再涂抹 15 g BLT，持续 20 分钟。A 组患者随后接受全消融激光治疗，B 组患者接受分段消融激光治疗。初始局部麻醉应用后 60、90、120、180 和 240 分钟时抽取血样，分析血清中利多卡因和单乙基甘氨酰二甲苯（MEGX）水平。患者在治疗过程中每隔一段时间对疼痛进行评分。
无患者需要补充神经阻滞。两组在第一次通过结束时的疼痛评分相同（P =.436）。A 组患者在第二次激光治疗开始时的疼痛评分明显较低（P =.045），但到结束时疼痛评分相当（P =.323）。A 组患者的血清利多卡因和 MEGX 水平在 90 分钟时明显升高（A 组平均峰值为 0.61 µg/mL，B 组为 0.533 µg/mL；P =.0253），这对应于更大的初始镇痛效果。
本研究数据表明，激光预处理可增强面部年轻化的局部麻醉效果，同时保持安全的血清水平。进一步的研究应探讨最佳应用量和时间，以实现安全的多遍面部年轻化，而无需侵入性神经阻滞。
