Vascular region may impact ropivacaine duration in Mohs surgery

DENVER — Ropivacaine duration varies by anatomic region, with the anesthesia lasting shorter amounts of time in highly vascular regions, according to a presentation at the American Society for Dermatologic Surgery Annual Meeting.

“Understanding the properties of various anesthetics is imperative to accomplishing adequate pain control,” Kira Minkis, MD, PhD, director of Mohs and dermatology surgery, director of surgical, laser and cosmetic dermatologic education and associate professor of clinical dermatology at Weill Cornell Medicine, told Healio in an email interview. “Effective control of pain and anxiety is crucial during multi-stage Mohs micrographic surgery (MMS) or any dermatologic or cosmetic surgery in which patients are awake, aware and may experience prolonged intraoperative time.”

Researchers conducted an uncontrolled trial of 29 patients undergoing Mohs surgery on the nose and shin, two areas chosen to represent high and low vascular activity sites.

Sensation was determined by pinprick before injection of 0.5 mL of 0.2% subcutaneous ropivacaine at baseline and every 15 minutes until sensation returned or surgery was completed.

Of 29 patients, sensation duration lasted throughout the entire shin surgery for 22 patients (75.86%), with 3.5% regaining sensation within 1 hour.

Duration of ropivacaine in the nose ranged between 25 and 75 minutes (median, 60 minutes), and 75.9% of patients regained sensation within 1 hour.

“Use of subcutaneous ropivacaine in highly vascularized anatomical regions such as the nose results in significantly shorter duration of anesthesia compared to less vascularized regions such as the shin,” Minkis said. “This emphasizes a gap in effective pain control, but also an opportunity to improve our patients’ surgical and recovery experiences.