Phenol peels nerve blocks

Lip Eyelid formula was originally developed to treat only the lips and eyelids before its indications were extended to the full face. It can be applied locally without nerve blocks or any kind of anesthetic (see Chapter 36). A TCA Unideep peel (to the papillary dermis) is applied to the rest of the face immediately after the phenol peel has been applied locally (Figure 5.11). The Unideep must not come into contact with the skin that has been treated with phenol. 

Lidocaine as a preventive ( ) this point is highly debatable, since arrhythmia can be avoided simply by taking more than 1 hour to apply the phenol. Simple lidocaine used to do nerve blocks before the phenol peel should be considered a cautious technique. 

Raised telangiectasias may become more visible in patients with thin and transparent skin. Facial telangiectasias can be electrocoagulated immediately before the phenol is applied, while the patient is under nerve-block anesthesia for the peel. An Elhnan radiofrequency unit is completely satisfactory in this indication. 

There are many drawbacks to using this product in a full-face phenol peel its slow onset of action requires patience, and the nerve block takes about 30 minutes to set up but lasts 180-360 minutes. This product is painful to inject. The doses required to produce a nerve block of the whole face are lower than the neurotoxic doses, but not by much. As we saw above, the dose required for the face is at least 50 mg, while the toxicity threshold starts at 80 mg and the maximum allowed dose is 150 mg. As we saw in Chapter 28, Lalanne s experiment clearly shows that perivascular injections, even when the blood vessels have been properly dissected and are in plain view, can be followed by... 

The skin of the forehead is thoroughly anesthetized by the nerve blocks, and the phenol application should extend slightly into the temporal zone. Patients should be warned that they will feel a burning sensation on the temples for 15-20 seconds as the phenol is applied to this unanesthetized area. The temporal regions are treated gradually up to a virtual horizontal line that goes through the center of the pupils. The extension zone includes part of the wrinkles of the crow s feet the phenol is first applied at the base of these wrinkles the left hand stretches the skin to make it easier to reach the base of the wrinkles with the applicator. The peel solution is then applied to the rest of the area. 

Chapter 33 is devoted to the details of anesthesia for a phenol peel. Lip Eyelid formula can be applied without any anesthetic on small areas, however. Patients feel an intense burning sensation a few seconds after application. They will have been told that the burning sensation only lasts for 15 seconds and that they can have a nerve block if they want. Vocal anesthesia plays an important part, and the patient can take a paracetamol (acetaminophen) plus codeine tablet 1 hour before the treatment. Nerve blocks are often used to increase patient comfort 2% Hdocaine without adrenaline (epinephrine) is used, and its duration of action is sufficient. The patient should be given paracetamol plus codeine tablets for the post-peel pain, which is inevitable during the first 24 hours because of the severity and rapidity of inflammation caused by the peel. 

A localized Litton or Baker-Gordon peel can be carried out with short-acting nerve blocks with 2% lidocaine without adrenaline (epinephrine). The pain is also short-lived. Phenol provides anesthesia that extends about 1 cm beyond the frosting, and the phenol can be applied slowly, step by step. 

Phenol is neurolytic it makes the skin less sensitive for several days, and it is possible to touch up certain areas without causing any real pain after the nerve block anesthesia has worn off, even the day after the peel. Even if deep inflammatory phenomena make the dermis painful, the epidermis remains insensitive. 

A combination of paracetamol (acetaminophen) plus codeine is especially well suited to post-peel pain, but should not be used in the hours following a phenol peel, as paracetamol (a phenol derivative) goes through the same detoxification pathways as phenol, which could create metabolic competition and the risks of toxicity associated with phenol might be increased. Preventive administration of benzodiazepines (lorazepam 2.5 mg before the peel and on the night of the peel before going to bed) relieves the anxiety caused by these unpleasant sensations and reduces the need for analgesics after the peel. In case of very severe, localized pain (extremely rare), a nerve block could be used. 

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