Laser ablative treatment - local anaesthetic

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1 Laser ablative treatment - local anaesthetic Incorporating hospital and community health services, teaching and research

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3 The Homerton Anal Neoplasia Service is a referral centre that provides a screening and treatment service for people at risk, or, who have developed, precancerous lesions in the genital area. This includes the anal canal, the skin surrounding the anus, penis, vagina and vulva. We have a team of experts to give you information and look after you. This leaflet explains the preparation, treatment and after-care for laser ablative treatment with local anaesthetic. Why do I need this treatment? If someone is diagnosed with anal / genital pre-cancer, that is, areas of tissue with abnormal cell changes which have not been classed as cancer (usually found through biopsy samples), they may need treatment in order to reduce any cancer risk. You may have had a biopsy which showed precancer. Not all levels of pre-cancer need treatment. Usually only those moderate or severe precancer changes require treatment. Sometimes we will also treat people with warts that have not responded to other forms of treatment. Whilst treatment may not entirely prevent future development of cancer, there is agreement amongst specialists, that treatment of pre-cancer is the best option for prevention. Preparation for laser treatment Careful preparation for laser treatment before the event will help to overcome pain and speed up healing. It is important to know where exactly the treatment will be performed. This may be internal areas, external areas or both. If in

4 doubt please check with the doctor or nurse who saw you at your last visit. Have a meal beforehand With local anaesthetic injections, the amount of injections that we can use is limited by a number of factors. Most importantly, if you arrive for treatment without having eaten a full meal, we will not be able to proceed with the entire treatment. If you arrive without eating, we may rebook your appointment to another day. This is because patients can get unpleasant side-effects if they need a large number of injections and have not eaten. This may limit our ability to treat you. Please remember, if you are coming for treatment as an out-patient and are having a local anaesthetic, then you should eat beforehand EMLA cream should be applied to the area(s) to be treated. This is a cream that makes the area numb and you can collect it at the clinic where you were assessed. You may also call-in before your appointment at the Clifden Centre at Homerton Hospital, where we will be happy to provide you with some EMLA cream. The more EMLA cream that is applied, the more the chances are you will not feel any discomfort when local anaesthetic injection is given before your treatment. We recommend that you apply EMLA cream at least one hour before your appointment and repeat the application half an hour before your treatment. Sometimes there is a delay before your treatment, so it is a good idea to bring the tube with you and apply this while waiting to be called.

5 Someone to take you home It is important that someone accompanies you for this treatment, and, the journey home. Some patients may feel dizzy or weak after the local anaesthetic injections. Most patients will go home after local anaesthetic procedures with adequate pain-relief medication and advice. You will not be able to ride a bicycle or drive a motorised vehicle after your treatment. Treatment During treatment we will inject local anaesthetic under the skin using a very fine needle. With careful preparation, the discomfort experienced at this stage in the procedure will be greatly reduced. Injections will be repeated until numbness is achieved in the area to be treated. Once numbness occurs we will proceed with the laser therapy. Pain-relief medication. The effect of local anaesthetic injections will last for about two hours, enabling you to reach home, without encountering pain. It is important to start your pain-relief medication before the injections have a chance to wear off. We recommend that you take the first dose of analgesia at the earliest opportunity to minimise the effects of the laser therapy. After your laser procedure Some patients will need extensive treatment which will be accompanied by pain after the procedure. We recommend that you rest at home and take time off work. We will be issuing a medical certificate to enable you to do so. This period will vary depending upon the extent of treatment. It is important that you make adequate arrangements with your employer so that they are prepared for you to take time off. It is also important not to undertake any travelling during this period.

6 Laser treatment and after-care Laser treatment involves burning the skin / other similar internal lining where the disease was seen. This will result in local burn. The area affected may be small or large depending on how much disease there was. As with all burns there will be some associated local pain and oozing for a few days. Keeping the area open to air is recommended. It is best not to cover this area with clothing or any dressing. If this is not possible then loose clothing may help keep the area dry. Bathing is encouraged once or twice per day, and some patients find it helpful and soothing to have warm baths with some salt added. You will be supplied with some pain relief medication and local pain relief cream. We will also give you, if needed, a liquid medicine to prevent constipation. Constipation must be avoided as it is likely to cause damage to the new skin/lining that forms during healing. A high-fibre diet and adequate liquid intake will also help. Occasionally the wound can become infected or start bleeding. If infection occurs you may notice an increase in pain or a discharge.

7 Please contact your doctor or us at Homerton Hospital for advice and support. We sometimes give you antibiotics after your treatment if we think infection may be likely. However this is not needed in every case. You will be given an appointment to assess the treated area in three to six months after your treatment. For additional support/advice please call the HANS Clinical Nurse Specialist

8 Other useful information NHS Choices Cancer Research UK Patient Advice and Liaison Service (PALS) PALS can provide information and support to patients and carers and will listen to your concerns, suggestion or queries. The service is available between 9am and 5pm. : : : PALS@homerton.nhs.uk For information on the references used to produce this leaflet, please ring , textphone: or patientinformation@homerton.nhs.uk If you require this information in other languages, large print, audio or Braille please telephone the Patient Information Team on , text: or patientinformation@homerton.nhs.uk Produced by: Homerton Sexual Health Service, SWSH Homerton University Hospital NHS Foundation Trust Homerton Row, London E9 6SR enquiries@homerton.nhs.uk Date produced: March 2017 Review date: March 2019