title: 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.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Dermatology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Klein
authors.affiliation: Department of Dermatology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Karrer
authors.affiliation: Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Horner
authors.affiliation: Department of Dermatology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Werner
authors.affiliation: Department of Dermatology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Heinlin
authors.affiliation: Department of Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Department of Centre for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Koller
authors.affiliation: Department of Dermatology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Landthaler
authors.affiliation: Department of Dermatology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: R-M
authors.initials: RM
authors.lastname: Szeimies
authors.affiliation: Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Gruber
authors.affiliation: Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Graf
authors.affiliation: Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Hansen
authors.affiliation: Department of Anaesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kerscher
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D000698:Analgesia / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000704:Analysis of Variance; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D003080:Cold Temperature; D004177:Dipyrone / Q000008:administration & dosage; D005148:Facial Dermatoses / Q000188:drug therapy* / Q000503:physiopathology; D005546:Forehead; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007275:Injections, Intravenous; D055623:Keratosis, Actinic / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods; D009882:Ophthalmic Nerve; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement; D017060:Patient Satisfaction; D010778:Photochemotherapy / Q000009:adverse effects* / Q000379:methods; D017319:Photosensitizing Agents / Q000008:administration & dosage; D010892:Pirinitramide / Q000008:administration & dosage; D011788:Quality of Life; D012535:Scalp / Q000294:innervation; D012536:Scalp Dermatoses / Q000188:drug therapy* / Q000503:physiopathology; D014321:Trochlear Nerve
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D017319:Photosensitizing Agents; D010892:Pirinitramide; C475457:methyl 5-aminolevulinate; D004177:Dipyrone; D000622:Aminolevulinic Acid