Safety of Local Intracutaneous Lidocaine Anesthesia Used by Dermatologic Surgeons for Skin Cancer Excision and Postcancer Reconstruction: Quantification of Standard Injection Volumes and Adverse Event Rates
Abstract
BACKGROUND: Intracutaneous lidocaine is used for anesthesia in dermatologic surgery for skin cancer excision and repair with exceedingly low incidence of reported adverse events. OBJECTIVE: To measure (1) the quantity of lidocaine typically used for facial skin cancer excision and reconstruction; and (2) the frequency and character of associated adverse events. METHODS: Survey study of dermatologic surgeons with longitudinal reporting. Reported practice during 10 business days: (1) mean volume of 1% lidocaine per skin cancer excision; (2) maximum per excision; (3) mean per reconstruction; and (4) maximum per reconstruction. RESULTS: A total of 437 of 1,175 subjects contacted (37.2%) responded. Mean per excision was 3.44 mL (SD: 2.97), and reconstruction 11.70 mL (10.14). Maximum per excision was 6.54 mL (4.23), and reconstruction was 15.85 mL (10.39). No cases of lidocaine toxicity were reported, diagnosed, or treated. Incidence of adverse events possibly anesthesia related was >0.15%, with most (0.13%) being mild cases of dizziness, drowsiness, or lightheadedness from epinephrine tachycardia. CONCLUSION: Toxicity associated with local anesthesia other than lidocaine was not studied. Volumes of lidocaine in skin cancer excision and repair are modest and within safe limits. Lidocaine toxicity is exceedingly rare to entirely absent. For comparable indications, lidocaine is safer than conscious sedation or general anesthesia.
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The performance of the procedures with local anesthesia and vasoconstrictors (100 cases) in the outpatient setting (95 cases) did not show an increase in risks or complications for the patients.
“The performance of the procedures with local anesthesia and vasoconstrictors (100 cases) in the outpatient setting (95 cases) did not show an increase in risks or complications for the patients, data that have been well established in the literature.17, 18, 19, 20, 21”
From Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases (2021) · cites this paper as [17]
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Cherobin, A. C. F. P., & Tavares, G. T. (2020) · Anais Brasileiros de Dermatologia · doi:10.1016/j.abd.2019.09.025 · Cited by 106 · see citing works
Auricular reconstruction after Mohs micrographic surgery: analysis of 101 cases
Bittner, G. C., Kubo, E. M., Fantini, B. D. C., & Cerci, F. B. (2021) · Anais Brasileiros de Dermatologia · doi:10.1016/j.abd.2020.12.008 · Cited by 14 · see citing works
- Authors
- Alam, M., Schaeffer, M. R., Geisler, A., Poon, E., Fosko, S. W., & Srivastava, D.
- Affiliations
- Northwestern University (US)
- Otolaryngology, and
- Mayo Clinic (US)
- Saint Louis University (US)
- Corresponding author
- Alam, Murad
- Venue
- Dermatologic Surgery
- Published
- 2016-12
- Volume
- 42
- Issue
- 12
- Pages
- 1320-1324
- ISSN
- 1076-0512 (ISSN-L)
- 1524-4725
- OpenAlex
- W2530054532
- Cited by
- 23
- References
- 10
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 6 · 2020: 2 · 2019: 7
- FWCI
- 2.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Dermatologic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Dentistry › Oral Surgery › Dental Anxiety and Anesthesia Techniques
- Health Sciences › Medicine › Dermatology › Facial Rejuvenation and Surgery Techniques
- Keywords
- local anesthesia, skin cancer excision, lidocaine toxicity, adverse events, facial surgery
- MeSH terms
- Anesthesia, Local, Anesthetics, Local, Cross-Sectional Studies, Epinephrine, Head and Neck Neoplasms, Humans, Injections, Intradermal, Lidocaine, Longitudinal Studies, Practice Patterns, Physicians', Skin Neoplasms, United States, Mohs Surgery, Plastic Surgery Procedures, Patient Safety
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