Clinical Observation of Anesthesia Effect of 2% Lidocaine by Air Pressure Injection in Facial Skin Aesthetic Treatment

Ming-xing CHEN,Yang-liang YI,Yan-mei WANG,Jing-jing ZHAO,Yong-sheng HAO,Kai-shan LIU,Xiao-hong YANG,Jin WANG

Department of Beauty Dermatology,Guangzhou Huamei Medical Beauty Hospital,Guangdong Province,510000,China

ABSTRACT Objective To observe the anesthetic effect of 2% lidocaine with Pneumatic injector spray in facial beauty therapy.Methods 240 patients were randomly divided into two groups:the observation group (n=120)was treated with 2% lidocaine before the treatment,and the observation group (n=120)was treated with 2% lidocaine.120 cases of control group were treated with compound lidocaine cream before treatment.The onset time of anesthesia,the effect of anesthesia and adverse reactions were recorded.Results In the pneumatic spray group,the effective time of anesthesia was 5 minutes.Acupuncture had no pain,and the incidence of allergy was 0.8%.The control group:the effective time of anesthesia was 20 minutes.Acupuncture has pain in the skin and can be tolerated.The incidence of allergy was 10.8%.There was significant difference between the two groups (χ 2=8.82 P ＜ 0.01).Conclusion The injection of 2% lidocaine in facial beauty therapy by air pressure spray instrument has the advantages of quick onset,good anaesthesia effect and less side effects,so it is worth popularizing and applying in clinic.

KEY WORDS Lidocaine spray surface anesthesia

Aesthetic treatment of the face is gaining popularity,Intraoperative anesthesia management is one of the key factors in treatment.At present,the common method is superficial anesthesia.Apply lidocaine containing ointment to the face.Although this method can complete most of the treatment,but there are some patients anesthesia effect is not good,easy to appear allergic reaction,we want to find another kind of simple operation,good anaesthetic effect and less side effect method,we try to use 2% lidocaine injection pressure spray tester injection to treat area,has played a very good surface anesthesia effect,this method has not been reported in China.

MATERIAL AND METHODOLOGY

General Material

From August 2016 to December 2018,240 out-patients finished plastic surgery in dermatology department of our hospital,among whom were 102 patients with facial pigmented dermatosis treated by laser,58 patients with facial aging (skin dry,thinning,losing luster,wrinkles)treated by radio frequency,52 patients with hyaluronic acid injected by ordinary electronic syringe,and 28 patients with facial aging (skin dry,thinning,losing luster,wrinkles)treated by ultrasound.They were randomly divided into two groups:120 cases in the observation group,all female,aged 30-43 years old,with an average age of 35.49 years old,time length of skin aging and pigmented dermatosis from 1 month to 3 years,with an average of 5.55 months;120 cases in the control group,all female,aged 31-42 years old,with an average age of 34.28 years old,time length of skin aging and pigmented dermatosis from 1 year to 3 years,with an average of 5.57 months There was no significant difference in age,disease type and course between the two groups (P >0.05).

Exclusion Standard

Patients with facial wound or infection focus,allergic to lidocaine and photoallergy,with hepatitis,tuberculosis,infectious disease history,pregnancy,breast-feeding,and other serious organ diseases were excluded.Indications suitable for laser and photon therapy are:facial chloasma,freckles,café-au-lait spots,age spots,etc.Indications suitable for ultrasound scalpel and radio frequency therapy are:skin dry,thinning,losing luster,wrinkles,etc.

Pain Evaluation Standard

VSA pain rating scale was used as the evaluation index of pain effect.VSA divided pain into 10 grades,0 for painfree,and 10 for the strongest pain.For the convenience of statistics,it was divided into three grades in this study:0-3 as grade I,4-6 as grade II,and 7-10 as grade III.Grade I:The patient’s facial expression is stable and painless;Grade II:slightly painful yet tolerable;Grade III:feeling pain,painful facial expression,unbearable［1］.Grade I and II are defined as effective and Grade III as ineffective.

Therapeutic Methods

All 120 patients in the treatment group were strictly disinfected and then sprayed 2% lidocaine of 3-10 ml within the range of skin treatment by ML-1701 pneumatic spray instrument (produced by Wuhan Qizhi Laser Technology Co.,Ltd.,production license:Hubei Province Food,Medicine and Medical Devices Approval No.20150128).The gas pressure was set at 0.65 Mpa±20%and the liquid flow rate was 2ml/min±20%.5 minutes later,stuck with a needle and determine the anesthetic effect according to the patient’s pain tolerance[1].

All 120 cases in the control group were smeared with compound lidocaine ointment (national medicine standard H20063466,manufacturer:Beijing Ziguang Pharmaceutical Co.,Ltd.,implementation standard:YBH02032006,approval number:national medicine standard H20063466)on the skin surface to be treated;20-30 minutes later,stuck with a needle and determine the anesthetic effect.

Adverse Reaction

Allergic reaction:facial erythema,urticaria with itching,burning,etc.

Statistic Methods

All data were processed by SPSS 17.0 software andχ2test.

RESULTS

Anesthetic effect and side effect in two groups were compared:

Table 1:Anesthetic effect and side effect in two groups

COMPLICATIONS

1 case of facial erythema,urticaria with itching,burning in the treatment group,while 12 cases of facial erythema,urticaria with itching,burning in the control group.After allergy,all patients were wet compressed with 5%dexamethasone solution.After 15 minutes,the symptoms disappeared and the rash subsided.

DISCUSSIONS

Treatments for facial aesthetics include laser,photon,radio frequency[2-4],ultrasound,electronic injection,roller microneedle,etc.The above treatment mostly needs topical anesthesia to alleviate pain,in order to enable doctors to successfully complete the treatment.At present,in most cases,compound lidocaine ointment is applied on the surface of non-destructive facial skin and covered with plastic film for topical anesthesia,which mainly through the release of lidocaine and alamine to the subcutaneous and cortical layer,through the accumulation of lidocaine and alamine in the cortical pain receptor and nerve endings,thus reaching the cortical layer for the anesthesia effect[5-7].

As amide local anesthetics,lidocaine and alamine stabilize the nerve cell membrane by blocking the ion flow required for the generation and transmission of nerve impulses,thus producing local anesthesia.However,there are many problems,because the skin has limited absorption of the ointment,and it takes a long time,the anesthetics in the ointment cannot quickly and sufficiently enter the skin and subcutaneous.The result is that the anesthesia effect is not good with longer time to take effect and proneness to allergy for the composition of the ointment,which was mainly manifested by contact dermatitis[8 9].This paper found that the allergic rate was 10.8%.The causes of allergic reactions may be related to the ingredients used by different manufacturers,such as preservatives.

The principle of pneumatic spray instrument is to press the liquid into the skin through the pore of the skin via high pressure,so that the drug can penetrate into the surrounding tissues without damaging the skin.The effect is the same as that of normal injection[10、11].Because of its large dosage of injection,it can reach the amount of drug needed in ordinary anesthesia［12］while taking less time to handle,take effect and achieve normal anesthesia effect.88 cases achieved Grade I anesthesia effect at efficiency of 74% and 31 cases achieved Grade II anesthesia effect at efficiency of 26.1%;the total effective rate is 99%.Lidocaine can cause allergies[13].However,only 1 patient had allergic reactions in this data with the allergic rate of 0.8%.This is because pure lidocaine injection has fewer components and impurities than cream,and more anesthetics stay in the intradermal and subcutaneous tissues while less anesthetics enter the blood,allergic reactions are rare［14］and allergic shock is not easy to occur.

At present,there is no report on the application of lidocaine injection by pneumatic jet for surface anesthesia in domestic published literature.However,there have been similar reports abroad about the use of pneumatic lidocaine injection for skin topical anesthesia［15,16］.Caltagirone R et al.study on the possibility of local anesthesia increasing LPs success rate for febrile infants undergoing lumbar puncture (LPs)to examine meningitis.Comparing the effect of local anesthesia with 1% lidocaine injected by high pressure pneumatic spray instrument with TA cream,we conclude that:J-Tip is not better than TA cream in pain control or physiological changes according to randomized controlled trials of two local anesthesia methods.Successful rate of infant LPs with J-Tip is twice of that with TA cream.

From this conclusion,it can be seen that topical anesthesia with pneumatic spray instrument is a feasible method.Kelly,S.et al.study the change of peripheral venous catheterization in pediatrics.Local injection of 1%lidocaine with high pressure pneumatic spray instrument before venous catheterization in children can reduce the pain of venous catheterization in children.Conclusion:Needle-free injection of lidocaine during peripheral venous catheterization in pediatrics is an effective method to relieve pain in children aged 3-16 who receive intravenous infusion.It can be seen from this conclusion that lidocaine injected by high pressure pneumatic spray instrument for skin topical anesthesia is also successful and feasible.Caltagirone R’s conclusion that J-Tip is not better than TA cream may result from the fact that they use 1%lidocaine with less amount of anesthetics,while we use 2% lidocaine which has relatively better anesthetic effect for higher concentration.

2% Lidocaine by Air Pressure Injection in Facial Skin Aesthetic Treatment has the characteristics of simple operation,quick onset of anesthesia,good anesthesia effect,few side effects and low cost.