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Doris Day, MD, a dermatologist in New York City, N.Y., compares having the Pro-NoxTM pain management analgesic device from CAREstream America (Lake Mary, Fla.), at her practice to her love for French fries. “It is funny. When I go to restaurants I ask, ‘What comes with French fries?’ I sort of love the French fries more than the main course,” Dr. Day shared. “And when people come in and have had a cosmetic treatment with Pro-Nox, they say, ‘so, what else comes with Pro-Nox?’”
Pro-Nox does not make patients’ faces younger looking or bodies more toned, but it does remove a major barrier to certain treatments – pain – making it possible to fully optimize each treatment more efficiently, resulting in patients looking forward to their next procedure with Pro-Nox, Dr. Day indicated.
Pro-Nox is an FDA-cleared pain management device that delivers a fixed blend of nitrous oxide, or laughing gas, and oxygen. Patients self-administer and control the amount of gas delivered as needed. According to Dr. Day, Pro-Nox answers the “Will it hurt?” question.
Studies have shown that Pro-Nox helps by decreasing the sensation of pain and patients’ recognition of the presence of pain, as well as diminishing the patient’s anxiety.
Authors of a German study looking at the use of nitrous oxide analgesia in the setting of aesthetic dermatology concluded: “The pronounced analgesia, the easy self-administration, the fast onset and complete recovery after a few minutes, as well as the low ratio of side effects make the N2O/O2 inhalation an ideal addendum in the management of larger painful dermatologic procedures as long as contraindications and safety precautions are respected.”1
“Pro-Nox makes everything just so much more pleasurable,” Dr. Day stated. “Knowing that they have something they can control and count on that is going to help with that discomfort makes everything better even before a patient has treatments done. Their heart rate is down, blood pressure is down, risk of bruising is down, the procedure goes faster and they are just very happy.”
Joel L. Cohen, MD, director of AboutSkin Dermatology and DermSurgery in Greenwood Village, Colo., frequently uses Pro-Nox for the more uncomfortable laser procedures – specifically, for heavy, full-field Erbium resurfacing. “People often have anxiety about the procedure and about the nerve blocks. Pro-Nox helps to take the edge off all of that,” Dr. Cohen expressed.
To prepare for full-field laser resurfacing, Dr. Cohen asks patients to take about five to seven deep breaths of Pro-Nox as a loading dose.
“I will then start with the regional blocks and numbing. As the Pro-Nox starts to attenuate in four to five minutes, we will have them take a few more deep breaths to get them to a point where we can finish the nerve blocks and start the resurfacing,” Dr. Cohen noted.
Using Pro-Nox has all but eliminated the need for Dr. Cohen to write Ativan (lorazepam) prescriptions for patients. “With a good regional block in most areas, patients feel pretty comfortable in terms of pain. They do feel some heat and vibration, and for some people that leads to a bit of anxiety. So, we typically blow the Zimmer cooling device onto them and give them the opportunity to have more Pro-Nox when they feel they need it.”
Dr. Day likes Pro-Nox as a physician because it is an analgesic, not anesthesia. “I don’t need to update anything in my malpractice. I don’t need to do any monitoring,” she explained. “I also like that patients self-administer Pro-Nox. It is something that they breathe in and out. It is not something that is forced on them at a certain rate.”
Even though Pro-Nox is an analgesic, it helps with both the pain and the anxiety, Dr. Day reiterated. “Patients can feel some discomfort, but they don’t care. And they don’t have the anxiety that goes with it, which is often more than the discomfort itself,” Dr. Day pointed out. “Then, it clears out of their system within five to ten minutes, so they can drive home and get back to their lives. I don’t have to worry about them operating heavy machinery, as I do with some other medications.”
Dr. Day uses Pro-Nox before and during treatments that result in some discomfort, including ultrasound- and radiofrequency-based tightening devices like Sofwave (Sofwave Medical Devices), Ultherapy (Merz Aesthetics) and Thermage (Solta Medical).
“There are also people who have anxiety around just getting neurotoxin injections, so I take that anxiety away (with Pro-Nox). Some people are just really, really sensitive, so we let them know that we have it if they want it,” Dr. Day shared.
Jason Pozner, MD, of Sanctuary Plastic Surgery in Boca Raton, Fla., has been using Pro-Nox for about four years, on more than 1,000 patients.
Pro-Nox is so popular and useful at his practice that one-third of his revenue is now from local anesthesia cases, which has fueled higher profits in recent years.
“I do a lot of small area liposuction cases, fat grafting, laser resurfacing and eyelid surgery, and use Pro-Nox in many of those cases,” Dr. Pozner advised. “For nervous patients we also use Pro-Nox for neurotoxin and fillers, and they can drive home because it clears in five minutes or so,” he reiterated.
At Dr. Pozner’s practice, Pro-Nox has been a game changer during other popular proce- dures, as well, including Ultherapy, Sofwave and MiraDry (Sientra). The cost of having Pro- Nox for the practice is reasonable, according to Dr. Pozner. “We have three Pro-Nox units going all the time.”
1. Drosner M. Lachgas-Sauerstoff-Inhalation zur Analgesie in der ästhetischen Dermatologie [Nitrous oxide - oxygen analgesia in aesthetic dermatology]. Hautarzt. 2013;64(6):435-442. doi:10.1007/s00105-013-2588-z.