Laughing gas if you’re extra-nervous or squeamish with needles …

  • Posted on: Jan 18 2017

All the vein procedures I do, from cosmetic injections to advanced stent placement for severely obstructed veins are done safely in my office. Some, however, involve multiple needle sticks that discourage some people from seeking the treatment they both need and want. Although the majority of patients I see ranging from teenagers to 80+ year-olds tolerate these needles indifferently, many needle-phobic patients desperately seek options to lessen their anxiety and pain.

In my experience, topical anesthetic creams like concentrated Lidocaine are both ineffective and impractical, considering the large areas that sclerotherapy, saphenous vein closure, and phlebectomy involve. Oral Valium or Ativan to reduce anxiety can help take the edge off, but they must be taken well in advance of your treatment, offer the equivalent of only a martini or two, and require someone to drive you home.

Furthermore, many years ago I decided it was not worth either your or my time to go to a surgicenter, where hidden anesthesiologist and surgicenter fees, the wasted time measured in hours it takes to get the procedure done and the impracticality of having someone drive you home are all so off-putting. Although an itinerant anesthesiologist can give Propafol safely in my office, the anesthesia fee is not reimbursed by insurance and must wait until I can do two or more patients on the same day, since anesthesiologists do not want to come for a single patient.

Recently, I decided to try laughing gas. Nitrous oxide has long been used in the dentist’s office.  It is now available in a system (Pronox©) which mixes half nitrous oxide and half oxygen. This combination relaxes you, provides some but not complete anesthesia, and dissipates immediately after you stop breathing the gas, allowing you to drive home. You remain awake and able to shift position during the procedure, which is important in saphenous ablation and other vein treatments.

Best of all, I have found that even my most nervous and needle-phobic patients love it.


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Posted in: Varicose veins