Safety of Intradermal/Subcutaneous Lidocaine With Epinephrine Use in Dermatologic Surgery
Jason M Hirshburg1, Dayna G Diven1, Chloe Edmiston2
1Dell Medical School, University of Texas at Austin, Austin, Texas.
Background:
Recently, the safety of lidocaine plus epinephrine use in outpatient surgery has come under scrutiny despite its long history of use in outpatient dermatologic procedures and surgeries.
Objective:
To assess the frequency of crash cart and other emergency interventions during Mohs micrographic surgery when lidocaine plus epinephrine is used as a local anesthetic and evaluate patient comorbidities associated with these events.
Materials And Methods:
A retrospective chart review was conducted in an outpatient Mohs micrographic surgery clinic.
Results:
One thousand one hundred twenty-seven Mohs cases were reviewed from the period of March 2015 to June 2016 with 864 meeting the inclusion criteria of patient weight, medical history, and amount of lidocaine administered recorded. No adverse events requiring emergency intervention with a crash cart or transfer to the emergency department occurred despite a patient population with advanced age and a wide range of comorbidities.
Conclusion:
No serious adverse events requiring emergency intervention were associated with lidocaine with epinephrine doses administered below the Food and Drug Administration recommended maximum. The authors did not find evidence from this study or after a literature search to support the requirement for a crash cart and other emergency equipment to be present during procedures.
Insights
Lidocaine with epinephrine is safe for Mohs surgery, even in older patients with health issues. This study found no emergency events, questioning the need for crash carts during these procedures.
Area of Science:
- Dermatology
- Anesthesiology
- Surgical Oncology
Background:
- Lidocaine with epinephrine is a common local anesthetic in outpatient surgery.
- Its safety in outpatient settings, particularly Mohs surgery, has been questioned.
- Despite concerns, it has a long history of use in dermatologic procedures.
Purpose of the Study:
- To determine the rate of emergency interventions during Mohs surgery using lidocaine with epinephrine.
- To identify patient comorbidities associated with adverse events.
- To evaluate the necessity of crash carts in Mohs surgery.
Main Methods:
- Retrospective chart review of 864 Mohs micrographic surgery cases.
- Data collected included patient weight, medical history, and lidocaine dosage.
- Cases were from an outpatient Mohs surgery clinic between March 2015 and June 2016.
Main Results:
- No adverse events requiring emergency intervention or crash cart use occurred.
- The patient cohort included individuals with advanced age and various comorbidities.
- Lidocaine with epinephrine doses were administered below FDA-recommended maximums.
Conclusions:
- Doses of lidocaine with epinephrine below FDA maximums were not associated with serious adverse events in this Mohs surgery cohort.
- The study did not find evidence to support mandatory crash cart presence for these procedures.
- Further research may clarify safety protocols for local anesthetics in outpatient surgery.
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