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Liposomal and Nonliposomal Bupivacaine for Mohs Surgery: A Systematic Review

George M Jeha1, Hannah R Malinosky1, Laura Taylor2

  • 1Louisiana State University Health Sciences Center, New Orleans, Louisiana.

Dermatologic Surgery : Official Publication for American Society for Dermatologic Surgery [Et Al.]
|October 20, 2023
PubMed
Abstract

Insights

Bupivacaine may offer better pain control for Mohs micrographic surgery (MMS) compared to lidocaine, potentially reducing postoperative pain and opioid use. Further research is needed to confirm these benefits.

Area of Science:

  • Dermatology
  • Anesthesiology
  • Surgical Oncology

Background:

  • Lidocaine is the standard local anesthetic for Mohs micrographic surgery (MMS), but its short duration often leads to significant postoperative pain.
  • Bupivacaine, known for longer-lasting analgesia in other procedures, has not been extensively studied for MMS.

Approach:

  • A systematic review followed PRISMA 2020 guidelines, searching MEDLINE, PubMed, and EMBASE for studies on bupivacaine in MMS.
  • Included studies compared bupivacaine (including liposomal formulations) to traditional local anesthetics in MMS patients.

Key Points:

  • Three studies with 253 patients were included.
  • Bupivacaine demonstrated good tolerability.
  • Results indicated comparable or reduced intraoperative/postoperative pain and opioid consumption with bupivacaine versus lidocaine.

Conclusions:

  • Bupivacaine shows potential for extended intraoperative anesthesia and reduced acute postoperative pain and opioid use in MMS.
  • Larger, prospective trials are necessary to validate the clinical efficacy and generalizability of bupivacaine for MMS pain management.

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