Risk of adverse events due to high volumes of local anesthesia during Mohs micrographic surgery
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ORIGINAL PAPER
Risk of adverse events due to high volumes of local anesthesia during Mohs micrographic surgery James Randall Patrinely Jr1 · Charles Darragh2,3 · Nicholas Frank4 · Brandon C. Danford5 · Lee Wheless6 · Anna Clayton6 Received: 31 March 2020 / Revised: 8 August 2020 / Accepted: 17 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract General guidelines for the maximum amounts of locally injected lidocaine exist; however, there is a paucity of data in the Mohs micrographic surgery (MMS) literature. This study aimed to determine the safety and adverse effects seen in patients that receive larger amounts of locally injected lidocaine. A retrospective chart review of 563 patients from 1992 to 2016 who received over 30 mL of locally injected lidocaine was conducted. Patient records were reviewed within seven postoperative days for complications. The average amount of anesthesia received was 40 mL, and the average patient weight was 86.69 kg. 1.4% of patients had a complication on the day of surgery, and 4.4% of patients had a complication within 7 days of the surgery. The most common complications were excessive bleeding/hematoma formation and wound infection. Only two complications could be attributable to local anesthetics. Gender, heart disease, hypertension, diabetes, and smoking were not significant risk factors for the development of complications. MMS is a safe outpatient procedure for patients that require over 30 mL of locally injected anesthesia. The safety of high volumes of lidocaine extends to patients with risk factors such as heart disease, hypertension, diabetes, and smoking. Keywords Lidocaine · Local anesthetic · Mohs · Reconstruction
Introduction Non-melanoma skin cancers are some of the most prevalent cancers and commonly treated with Mohs micrographic surgery (MMS) when present in cosmetically sensitive or technically challenging anatomical areas [1]. MMS is usually performed in an outpatient office setting with local anesthesia. This lowers costs, increases efficiency, and eliminates complications associated with general anesthesia [2, 3]. * James Randall Patrinely Jr [email protected] 1
Vanderbilt University School of Medicine, 200 21 st Ave S, Nashville, TN 37203, USA
2
Carolina Dermatology of Greenville, Greenville, SC, USA
3
Clinical Faculty, University of South Carolina SOM- Greenville, Greenville, SC, USA
4
Ochsner Medical Center, New Orleans, LA, USA
5
Dallas Associated Dermatologists, Dallas, TX, USA
6
Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
With some larger tumor resections, higher volumes of local anesthetics are necessary and potentially create a greater chance of anesthetic complications. Local anesthetics block action potential propagation by antagonizing sodium channels. This slows axonal conduction to temporarily impair nerve function [4]. Variations of amide anesthetics, commonly lidocaine, are routinely used in MMS. The maximum recommended dose depends on
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