Alternate methods of analgesia: Recommendations

Alternate methods of analgesia: Recommendations

Does the use of other commonly used techniques minimize pain?
  • There is contradictory evidence regarding the effectiveness of ethyl chloride, and its use as a sole method for analgesia in dermatologic procedures should not be considered. 
    Strength of recommendation: C   Level of evidence: III

  • Cold air skin cooling may be considered to reduce patient discomfort during non-ablative laser therapy
    Strength of recommendation: B   Level of evidence: II

  • Use of a skin-vibrating device may be considered to help decrease the pain of botulinum toxin injection.
    Strength of recommendation: B   Level of evidence: II

In addition to anesthetic drugs, multiple other modalities are available to alleviate patient discomfort during dermatologic procedures. There is a great deal of variability in the level of evidence to support these methods however. There is contradictory evidence regarding the pain reduction potential of ethyl chloride, with some studies showing benefit, some finding no benefit, and one showing that no anesthetic was superior.103-107 Many of these studies were not blinded due to infeasibility, and the interventions evaluated were difficult to compare to one another.  Additionally, all of the investigations of ethyl chloride were conducted to assess its use in venipuncture, venous cannulation, or skin prick testing, which are different from procedures performed by dermatologists.

Citation note

When referencing this guideline in a publication, please use the following citation: Kouba DJ, LoPiccolo MC, Alam M, Bordeaux JS, Cohen B, Hanke CW, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016 Feb 27. pii:S0190-9622(16)00074-8. 


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