Nitrous oxide - oxygen analgesia in aesthetic dermatology

Local anaesthesia often is insufficient for more extensive procedures. Instead of general anaesthesia or sedation, pediatricians, gynaecologists and dentists increasingly use nitrous oxide (N2O). This study evaluates the suitability of this form of anesthesia in dermatology. In 24 patients (18 w, 6 m, mean age 49 y.) N2O/O-2 inhalation (LivopanA (R)) was used during 46 procedures with indications including fractional RF/wrinkle reduction, IPL/rosacea, q-sw. laser/tattoos and hemosiderosis as well as fractional Er:Glass laser for scars and hypopigmentation. In 26 procedures subjective pain intensity was measured (visual analogue scale 0-10). With N2O the treatment pain was lowered from 6.6 +/- 1.6 to 2.9 +/- 1.7 (median, p = 0.000). 23/24 patients chose N2O for their next treatment. Beside euphoria, fatigue, slight drowsiness, dizziness, nausea or change in auditory perception, no other side effects occurred. The pronounced analgesia, the easy self-administration, the fast onset and complete recovery after a few minutes and the low ratio of side effects make the N2O/O-2 inhalation to an ideal addendum in the management of larger painful procedures in dermatology as long as contraindications and safety precautions are respected.