Comparing cold‐air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial. (1st July 2015)

• Record Type: Journal Article
• Authors: Klein, A.; Karrer, S.; Horner, C.; Werner, A.; Heinlin, J.; Zeman, F.; Koller, M.; Landthaler, M.; Szeimies, R.‐M.; Gruber, M.; Graf, B.; Hansen, E.; Kerscher, C.
• Is Part Of: British journal of dermatology. Volume 173:Number 1(2015:Jul.)
• Page Start: 192
• Page End: 200
• Publication Date: 2015-07-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.13547
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: Photodynamic therapy (PDT) using methyl aminolaevulinate (MAL) is an effective treatment for extensive actinic keratosis (AK). However, pain is a major side‐effect of this therapy. Objectives: To investigate whether scalp nerve blocks (group 1) provide adequate pain relief during MAL‐PDT of the scalp and forehead in 32 men with baldness. Methods: The patients received intravenous (IV) analgesia [piritramide 7·5 mg IV, plus oral metamizole (40 drops 30 min prior to PDT)] in combination with cold‐air analgesia (group 2; IV analgesia) and cold‐air analgesia alone (group 3). Maximum pain was evaluated by means of a visual analogue scale (VAS) during and up to 300 min after PDT. Pain during PDT was further analysed according to a pain perception scale. Furthermore, we measured haemodynamics and investigated stress hormone levels in blood samples at different time points. Results: Maximum pain during PDT (primary end point) was significantly reduced in the treatment group receiving scalp nerve blocks (VAS 2·1 ± 1·3) compared with the treatment groups receiving IV analgesia (VAS 7·3 ± 1·1) and cold‐air analgesia (VAS 8·4 ± 2·0; P < 0·05). No significant difference was found between groups 2 and 3 with regard to pain relief ( P = 0·32). The increase in systolic blood pressure during the first 3 min of PDT was significantly lower for group 1 than for groups 2 and 3 ( P < 0·001). No correlation between stress hormone levels and pain were found. Conclusions: Scalp nerve blocks provide an effective method for pain management during PDT for patients with extensive AK.