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Elma D. Baron, MD; Lisbeth Harris, MSPH; William S. Redpath; Howard Shapiro, PhD; Fred Hetzel, PhD, JD; Grant Morley, MSc, MMedSc; David Bar-Or, MD; Seth R. Stevens, MD

Arch Dermatol. 2003;139:1288-1290.

Objective  To determine whether pretreatment of skin with erbium:YAG (Er:YAG) laser-assisted delivery facilitates the penetration of lidocaine cream to provide anesthesia suitable for needlesticks after just 5 minutes.

Design  Trial 1 was a double-blind randomized controlled trial, whereas trial 2 was a nonblinded randomized controlled trial.

Setting  The study was conducted in 2 facilities, an academic and a private clinical research unit.

Participants  A total of 320 healthy volunteers, aged 18 to 65 years and of any Fitzpatrick skin phototype.

Interventions  Trial 1 involved an Er:YAG laser pretreatment to disrupt the stratum corneum followed by an application of 4% lidocaine cream on one arm, and a laser pretreatment plus placebo on the other arm. Trial 2 involved an application of 4% lidocaine cream alone on one arm, and a laser pretreatment followed by an application of 4% lidocaine cream on the other arm.

Main Outcome Measure  Self-reported pain perception on a 100-mm visual analog scale after quick insertion and removal of a 25-gauge hypodermic needle on the treatment sites.

Results  Data from the 2 trials showed that there was a 62% pain reduction with laser pretreatment plus lidocaine compared with laser pretreatment plus placebo, and a 61% pain reduction with laser pretreatment plus lidocaine, compared with lidocaine alone. The decrease in pain in both trials was statistically significant (P<.001). Adverse events reported 48 hours after treatment were few and mild.

Conclusion  Treatment with the Er:YAG laser followed by lidocaine cream is a safe, effective, and efficient means of inducing skin anesthesia that significantly reduces the pain of hypodermic needle insertion.

From the Department of Dermatology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, Ohio (Drs Baron and Stevens); the Dermatology Service, Louis Stokes Veterans Affairs Medical Center, Cleveland (Drs Baron and Stevens); HealthONE Alliance, Denver, Colo (Ms Harris, Mr Redpath, and Drs Shapiro, Hetzel, and Bar-Or); and Norwood Abbey Ltd, Chelsea Heights, Victoria, Australia (Mr Morley). Mr Morley is employed by Norwood Abbey who funded the study and manufactures the device used in this study.

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