Taking the sting out of pain controlTaking the sting out of pain control

National report — Aside from meeting patients' medical needs, newer protocols in pain control can help practitioners obtain a competitive advantage, experts say.

To that end, cosmetic surgeons are embracing methods ranging from dental anesthetics and equipment to anesthetic peels, cooling mechanisms and hand-held massagers.

For years, "Cosmetic dentists have been using special gels, and then they perform either miniblocks injecting anesthesia to the gingival sulcus, or regional nerve blocks using a dental product called Septocaine (Articaine/epinephrine, Septodont)," says Kenneth Beer, M.D., director, Palm Beach Esthetic Institute and clinical instructor of dermatology, University of Miami.

Unlike infiltrating with lidocaine, he says, "Septocaine is easy to use, has a much faster onset (two to five minutes), provides a much greater degree of analgesia and lasts for a little over an hour." 

For facial aesthetic work, he says that by using small amounts around the appropriate nerves, "We're able to achieve good anesthesia without any tissue distortion, in contrast to lidocaine infiltration."

As such, he says Septocaine is far superior when treating nasolabial creases and marionette lines and, most significantly, when augmenting lips. When one uses Septocaine miniblocks for lip augmentation procedures, Dr. Beer says, "One can now take one's time. The patient is comfortable and doesn't move — making the injection easier for both physician and patient."

Additionally, Dr. Beer notes that patients who have a pleasant experience are more likely to return for additional procedures, and to refer their friends.

In conjunction with Septocaine, Dr. Beer says a pedal-operated dental infiltration pump (The Wand, Compudent) provides a constant rate of anesthesia injection.

"Patients feel much less discomfort when the injection is gradual and controlled," he says.

Dr. Beer adds that unlike lidocaine, which one must draw up into a needle, Septocaine comes in single-use glass ampules that load easily into the pump. He says this combination has won over patients who were formerly reluctant or difficult to treat.

Septocaine's Canadian equivalent is known as Septanest (Articaine HCl, Septodont), says Jean D. Carruthers, M.D., clinical professor of ophthalmology at the University of British Columbia, Vancouver.

"Because it's more alkaline than typical doctor anesthetics, it numbs people very deeply, but it doesn't bother them so much having it injected," as opposed to acidic anesthetics, she notes.

Among topical products, the Food and Drug Administration's July approval of the peel formulation formerly known as S-caine (lidocaine, tetracaine cream, ZARS Pharma/OrthoNeutrogena) is "very exciting," adds Ranella J. Hirsch, M.D., a Boston-based dermatologist in private practice and vice president of the American Society of Cosmetic Dermatology and Aesthetic Surgery (ASCDAS).

Compared to existing alternatives, Dr. Hirsch says the product provides "much more efficient and effective anesthesia of a uniform area."

Unlike user-applied topical products that can deliver somewhat uneven effects, she says, "There's very little opportunity for error with this product, because it goes on uniformly and peels off." From the perspective of her office staff, she adds, "It's very neat and easy."