• Elma D Baron, Lisbeth Harris, William S Redpath, Howard Shapiro, Fred Hetzel, Grant Morley, David Bar-Or, and Seth R Stevens.
• Department of Dermatology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, Ohio 44106, USA. edb4@po.cwru.edu
• Arch Dermatol. 2003 Oct 1;139(10):1288-90.

ObjectiveTo 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.DesignTrial 1 was a double-blind randomized controlled trial, whereas trial 2 was a nonblinded randomized controlled trial.SettingThe study was conducted in 2 facilities, an academic and a private clinical research unit.ParticipantsA total of 320 healthy volunteers, aged 18 to 65 years and of any Fitzpatrick skin phototype.InterventionsTrial 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 MeasureSelf-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.ResultsData 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.ConclusionTreatment 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.

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