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Lidocaine local anesthesia has less risk than conscious sedation or general anesthesia

Intracutaneous lidocaine local anesthesia for skin cancer excision and reconstruction had no reported toxicity in survey results, with less risk than conscious sedation or general anesthesia, according to research published in Dermatologic Surgery.

Murad Alam, MD, MSCI, of the departments of dermatology, otolaryngology and surgery at Northwestern University, Chicago, and colleagues conducted an online survey of 1,175 members or fellows of the American College of Mohs Surgery between June and October 2014.

Information gathered included reported practice during 10 business days including mean volume of 1% lidocaine per skin cancer excision; maximum per excision; mean per reconstruction and maximum per reconstruction. Practice demographics and type of local anesthesia most commonly used also was included in the survey.

There were 437 respondents for a completion rate of 37.2%.

Mean volumes of 1% lidocaine used were 3.44 mL (SD, 2.97) per excision and 11.7 mL (SD, 10.14) in reconstruction.

There was no incidence of lidocaine toxicity. Few cases of adverse events were reported and included mild dizziness, drowsiness, or lightheadedness related to tachycardia associated with epinephrine.

“Dermatologists who perform skin cancer excision and reconstruction surgery routinely use lidocaine with epinephrine in the outpatient clinic setting, as well as other practice settings,” the researchers wrote. “Indeed, the outpatient setting of these procedures may protect ambulatory patients from the substantial risks associated with hospital admission, as well as general anesthesia or conscious sedation. Similarly, the combination of skin cancer excision and postcancer reconstruction is a single procedure reduces the need to obtain anesthesia twice, and may further reduce the total dose required.”

“In the hands of trained dermatologists, it does appear that the risks associated with lidocaine local anesthesia are significantly less in quantity and severity than those that maybe incurred in other settings using conscious sedation or general anesthesia, which are associated with known, non-negligible hazards,” the researchers concluded. – by Bruce Thiel

Disclosure: The researchers report no relevant financial disclosures.