Topical Anesthesia in Cutaneous Head and Neck Surgery: A Randomized Controlled Trial.

Area of Science:

• Dermatology
• Surgical Oncology
• Anesthesiology

Background:

• Cutaneous head and neck surgery relies on local anesthetic (LA) for patient comfort and procedure success.
• Optimizing pain management during LA administration is crucial for patient experience.
• Topical anesthetics like EMLA cream and ethyl chloride spray are commonly considered for pain reduction.

Purpose of the Study:

• To compare the effectiveness of EMLA cream and ethyl chloride (EC) spray in reducing pain from LA administration.
• To evaluate patient-reported pain and procedural experience during cutaneous head and neck surgery.

Main Methods:

• A randomized controlled trial was conducted at a university-affiliated tertiary head and neck oncology center.
• Participants were randomized into four groups: EMLA cream, EMLA placebo, EC spray, and a control (no topical agent).
• Pain and procedural experience scores were collected, and statistical analyses (Mann-Whitney U, Kruskall-Wallis, Chi-square, Spearman's Rho) were performed.

Main Results:

• No significant difference in pain scores was found between EMLA (4), EMLA placebo (4.8), EC (5.8), and control (5) groups (P=0.19).
• Procedural experience scores were similar across all groups (P=0.02).
• Factors like surgical site (scalp), malignant lesions, and larger lesion surface area were associated with increased pain.

Conclusions:

• EMLA cream and ethyl chloride spray were ineffective in mitigating LA-associated pain for cutaneous head and neck surgery.
• Practitioners should reconsider the routine use of EMLA and EC for pain management in this context.
• Patient operative experience remains high irrespective of topical anesthetic application.