Photobiomodulation/Laser Therapy

Photobiomodulation Therapy in The Post-Operative Setting

  • September 17 2023
  • Ren Houyoux, CVT, LVT, CVDT, VNA, LSO

By Ren Houyoux, CVT, LVT, CVDT, VNA, LSO

Should we consider using the therapy laser with post-operative cases? In the field of Photobiomodulation therapy (PBMt), this is a common question. The answer to this of course is YES!

In most cases, we should use this modality as an adjunct to standard of care. Whenever we have a condition which includes inflammation, pain, and tissue damage, we need to ask ourselves why we should not use the laser. A surgical procedure entails creating acute inflammation, pain, and tissue damage. Therefore, photobiomodulation therapy is an important addition for post-surgical pain management. Not all cases require laser light therapy, but it is important that the medical team justifies why this modality should or should not be used for each specific case.

We all know the adage “time is tissue”, and this certainly holds true for postoperative patients. The best approach for pain management is to add laser light therapy to the medical care of the patient right after surgery. It is imperative for the laser operator treating a patient while it is still under or recovering from general anesthesia be vigilant about their delivery technique. The patient will not be able to provide conscious feedback to any discomfort. The operator must also be diligent in using a non-contact delivery with fresh incisions to prevent contamination. In controlling pain and inflammation, it is extremely important that the entire site (including the site of tissue manipulation and a healthy margin of normal tissue periphery) should be illuminated to induce an optimal clinical response. When lasing an unconscious patient we should always “paint” the site by continuously moving and not “hovering” over any area, making sure it is treated appropriately and entirely.

An important safety tip is that with any perioperative treatment, hemostasis must be established prior to lasing. When using the laser in this instance (Sx. = creating an acute tissue injury which induces the coagulation cascade as well as acute inflammation and pain), it is not recommended to lase over any active hemorrhage. A small amount of blood spotting on the incision can sometimes be seen but should not be more pronounced. The laser will not induce an active hemorrhage, but a little blood spotting is to be expected along the primary incision. So, except for the concern of active hemorrhage, we should be able to lase immediately post-op and thus provide for additional pain management to promote a healing environment for the site of tissue manipulation.

The biggest hurdle we often face is time management, especially when dealing with patients in their recovery period from general anesthesia. It is important to remember that PBMt offers a certain amount of flexibility in treatment applications. To best integrate PBMt in a post-op setting, it usually comes down to the individual clinic’s workflow and the skill of whomever is operating the laser. Some laser is better than no laser: If the team gets busy and no one can treat the patient ASAP after surgery, we must remember to deliver a treatment before that patient goes home, even if this treatment occurs a few hours later. Even if the patient did receive a treatment immediately post-op, another treatment prior to the case being discharged should be considered—especially if the surgery was particularly painful. It has been found that these types of cases can benefit from multiple daily treatments in the acute phase of convalescent care.

In medicine, we do not have the luxury of choosing our patients, but we do have the responsibility to treat them.  An effective team with experience will always find time for what is best for their patients. Photobiomodulation should be considered as the standard of care post-operative to reduce pain, inflammation, and aid in tissue healing.