Evaluating CO₂ Laser and Scalpel Surgery Pain Perception and Healing

Dr. Miguel Carreira

Miguel Carreira, PhD, MSc, DTO, Pst-Grd, DMD, DVM (professor of surgery in Veterinary Medicine at the University of Lisbon, Portugal and the clinical director of the private veterinary medical center Anjos De Assis) and colleagues have conducted three animal studies, evaluating patients’ pain perception during and after CO₂ laser surgery and healing, in comparison with conventional scalpel surgery.

First Study: Comparison of the Influence of CO₂-laser and Scalpel Skin Incisions on the Surgical Wound Healing Process

Dr Carreira’s first study compared post-op pain levels and healing after CO₂ laser surgery and scalpel surgery. Patients in the laser group exhibited lower pain levels and higher post-op comfort than those in the scalpel group. In addition, the study demonstrated that CO₂ laser incisions were associated with lower white blood cell count (indicating reduced inflammatory response) and minor tissue trauma, because the endothelial wall does not incur as much injury as with scalpel incisions, thus decreasing the plasmatic protein total and serum albumin extravasation levels, and promoting healing.

A ‘very good’ (normal skin) scar appearance at 8 days post-op was reported for the 100% laser group subjects, which is much greater than only 28.5% for the scalpel group subjects. The rest in the scalpel group were 57.2% with “good” or discrete or small hypertrophy of the skin, and 14.3% with “regular” or medium hypertrophy of the skin.^[1]

Second Study: Comparison of the Hemodynamic Response in General Anesthesia between Patients Submitted to Skin Incision with Scalpel and CO₂ Laser Using Dogs as an Animal Model

Dr Carreira’s second study has looked at hemodynamic responses (heart rate and different blood pressure parameters) in patients under general anesthesia and concluded that CO₂ laser was perceived as less painful than scalpel surgery. Compared to the scalpel, the CO₂ laser is characterized by lower extravasation of blood. By sealing blood and lymphatic vessels, and nerve endings, laser surgery significantly reduces the local inflammatory response, which is associated with lower levels of glucocorticoids, epinephrine and norepinephrine, and therefore with lower pain level.^[2]

Third Study: Comparative Study on the Plasmatic CRP Level Variation in Dogs Undergoing Surgery with CO₂ Laser and Scalpel Blade Incisions in a Pre- and Post-Surgical Time-Point

Dr Carreira’s latest study compared the plasmatic C-Reactive Protein (CRP) levels variation between the patients who underwent CO₂ laser surgery and scalpel surgery. CPR is and acute (inflammation) phase response protein and peri-operatively, plasmatic CRP level can help monitoring the level of tissue inflammation, as the increase in the level of CRP correlates with the surgical trauma intensity in the patient. For the CO₂ laser surgery patients, lower plasmatic CRP level variation was registered than for the scalpel group patients. The study concluded that the use of the CO₂ laser in surgery was associated with lower inflammatory response, promoting a more comfortable peri-operative period for the patient.^[3]

Dr Carreira’s studies conclude that, in comparison with scalpel surgery, the CO₂ laser surgery is associated with less intra- and post-operative pain, reduced inflammatory response and better healing.

References

1. Carreira ML, Azevedo P. Comparison of the Influence of CO₂-laser and Scalpel Skin Incisions on the Surgical Wound Healing Process. ARC J of Anesthesiology, 2016;1(3):1-8
2. Carreira ML, Ramalho R, Nielsen S, Azevedo P. Comparison of the Hemodynamic Response in General Anesthesia between Patients Submitted to Skin Incision with Scalpel and CO₂ Laser Using Dogs as an Animal Model. A Preliminary Study. ARC J of Anesthesiology, 2017;2(1):24-30
3. Silva L, Azevedo P, Ramalho R, Baião R, Nielsen S, Carreira ML. Comparative Study on the Plasmatic CRP Level Variation in Dogs Undergoing Surgery with CO₂ Laser and Scalpel Blade Incisions in a Pre- and Post-Surgical Time-Point. ARC J of Anesthesiology, 2018;3(4):3-11