Sedation methods for traditional CO2 laser?

Everyone uses a different combination of pain control in patients undergoing laser resurfacing.  We combine pain killers and sedative medications, as well as topical numbing and nerve blocks.  Our patients do not like to feel pain at all!  Most of all, it is best that you feel comfortable with your physician and trust they are experienced and will be with you throughout the healing phase of the procedure.  A pre and post treatment skin care regimen is extremely important as well.  I wish you the best of luck, Dr. Emer.

Because the fully ablative laser is a much more stimulating, painful process than fractional resurfacing, whenever I've used the Ultrapulse CO2 laser in the past, I've only ever done it under general anesthesia.  I would also place nerve blocks to help with post-treatment comfort.  This is what I would recommend to you.All the best,

Laser
resurfacing is considered to be a relatively less-invasive procedure.
Typically, topical numbing cream is applied to the areas that are to be treated
and is sufficient to buffer discomfort. If multiple areas of the face are being
treated, and if the patient is particularly sensitive, local anesthesia may
also be administered to further ease discomfort. Sedation anesthesia and any
combination is essentially a personal choice that should be discussed with the
doctor who will be performing your CO2 laser resurfacing prior to the day of
your scheduled treatment. Generally speaking having sedation makes the
procedure more comfortable and I advise using it for most patients.

     In my practice I use the Lumenis Ultrapulse CO2 laser which has handpieces that give a "fractional" treatment. This does mean it less deep but rather that there is a small bit of tissue that is left as normal between each laser pulse. Most of the newer lasers offer this technique. It is now what I consider to be the standard CO2 laser. A Fraxel laser is also fractionated but is not CO2. Remember, Fraxel is just a brand name and not a type of treatment.     Most of time we use oral sedation (Vicodin and Xanax to relieve both anxiety and pain) 45 minutes before the procedure as well as topical creams for local anesthesia. This is enough for most of my patients. I will give injections of local anesthesia as needed but prefer to do this only if the patient has pain during the procedure. I believe the local anesthesia injections cause more swelling and possible bruising which can extend the healing process. For patients who are extremely anxious and want to feel or remember no pain, we use a heavy IV sedation (Propofol, Fentanyl and Ketamine) administered by a board certified anesthesiologist in our fully certified surgical facility.     Each doctor has a different way of decreasing pain during the procedure and you must be comfortable with the physician and their results. If you remain nervous about the procedure ask the doctor if you can speak to one of their patients who has had the laser treatment.

As noted in the title, there is significant difference experienced with the various lasers as there may be a significant difference in the result.  Traditional laser (Of which I believe the Coherent Ultrapulse is the original cosmetic CO2 laser and still the gold standard) is considerable more painful because it penetrates  more deeply than shallow lasers such as Erbium or even the fractional CO2 lasers (which give less improvement than Ultrapulse to scars, aging, etc) Short of very deep sedation or general anesthesia there is no painless laser procedure. However, most patients find the treatments tolerable under oral sedation and topical anesthetic or injection blocks.  Oral fentanyl or a combination of valium to tranquilize and oxycodone to provide pain relief along with topical is my most common method.

It varies from practice to practice but we use a full general anesthetic for our patients.  It's a light general, but the patients are asleep and appreciate the fact that there is no discomfort to the operation.  We supplement this with local blocks to decrease the pain after they awake.