Laser sin anestesia para PWS

Journal Scan / Research · October 13, 2020

Treatment Tolerance and Parental Perspective of Outpatient Pulsed-Dye Laser Treatment for Port-Wine Birthmark Without General Anesthesia in Infants and Toddlers

TAKE-HOME MESSAGE

• Infants undergoing treatment of port-wine birthmarks with in-office pulsed-dye laser (PDL) were given pain scores by their parents using the validated EVENDOL measure. Immediately after treatment, pain scores were nearly 9.1 but then resolved to preprocedure levels upon leaving the office (~0.9; P = .0001). Almost 95% of parents preferred their child being treated in an outpatient setting rather than an operating room, and nearly 76% preferred to be in the room with their child during treatment. Parents reported that their children could remember the laser treatment at a mean age of 12 months. Approximately 43% and 38% of parents said they were extremely satisfied or very satisfied with treatment, respectively.

• Although unable to assess the long-term psychological impact of painful laser treatments on infants, if any, this study suggests that in-office port-wine birthmark treatment by PDL without analgesia is well-tolerated, with rapid resolution of pain. Early and frequent treatment is optimal, however, as children start recalling the treatment at a mean age of 12 months.

– Margaret Hammond, MD

Written by

 

 

Sarah L. Chamlin MD

This group enrolled 47 infants with port-wine stains undergoing office pulsed-dye laser therapy. The investigators measured pain using validated infant pain scales. Of note, the pain was high immediately after treatment and normal by the time the infants left the office. The use of a metal corneal shield, age, and laser fluence did not impact pain scores.

Because of the possible neurodevelopmental effects of repeated general anesthesia, more practitioners are performing office laser treatments in young infants, and this study mirrors current experience. Infants seems to tolerate this procedure well and recover quickly with little pain immediately after procedure completion. Office laser can be repeated until the infants are older and are too difficult to restrain easily and safely, often by 12 to 18 months. Swaddling, oral sucrose, and immediate feeding after the procedure completion are excellent strategies to help control discomfort. In addition, nurses and staff who are adept at holding an infant still is of utmost importance.

Abstract

While there are robust data regarding the safety and efficacy of port-wine birthmark (PWB) treatment with pulsed dye laser (PDL) in early childhood,1,2 empiric data regarding pain, tolerability, and the parental perspective of in-office PDL treatment without general anesthesia are lacking. Understanding and quantifying these patient-centered outcomes and perspectives are critical to facilitate patient-clinician discussions and promote shared decision-making, especially given concerns of repeated general anesthesia's neurocognitive effects in young children.3

Journal of the American Academy of Dermatology

Assessment of Treatment Tolerance and Parental Perspective of Outpatient Pulsed-Dye Laser Treatment for Port-Wine Birthmark Without General Anesthesia in Infants and Toddlers

J Am Acad Dermatol 2020 Sep 30;[EPub Ahead of Print], H Feng, G Materne, S Ghalili, M Lederhandler, H Pomerantz, M Christman, LJ Bernstein, RG Geronemus 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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