INTRODUCTION
Local anesthesia is used in over one-million cutaneous surgeries per year, allowing providers to successfully perform many outpatient and office-setting surgeries.1 However, administration of local anesthesia has drawbacks, including the subjective pain and associated anxiety experienced by patients during administration.2 In addition, there are significant central nervous, cardiovascular, and respiratory system adverse effects associated with local anesthetic toxicity.3
Lidocaine, one of the most commonly administered local anesthetics, is frequently used at a 1% concentration in dermatologic surgery.4 Previous studies show that 0.5% lidocaine with a 1:200,000 epinephrine dose has equivalent anesthetic effects as a dose of 1.0% lidocaine with 1:100,000 epinephrine during Mohs micrographic surgery.5 For skin biopsies, even lower concentrations of 0.1% lidocaine are sufficient.6
Various methods to mitigate the pain of infiltration have been proposed and employed in practice. Buffering of the local anesthetic solution with sodium bicarbonate is one of the most well-known, but benzyl alcohol, a preservative found in bacteriostatic normal saline, also has been shown to diminish the pain of injections.6,7,8 Additionally, given the continued shortage of local anesthetic, judicious use of available local anesthetic is important and identification of the lowest effective dose is crucial.9 This study examined the pain of infiltration and duration of anesthesia of different anesthetic solutions to find the combination that minimizes the amount of local anesthetic used while maximizing patient comfort.
Lidocaine, one of the most commonly administered local anesthetics, is frequently used at a 1% concentration in dermatologic surgery.4 Previous studies show that 0.5% lidocaine with a 1:200,000 epinephrine dose has equivalent anesthetic effects as a dose of 1.0% lidocaine with 1:100,000 epinephrine during Mohs micrographic surgery.5 For skin biopsies, even lower concentrations of 0.1% lidocaine are sufficient.6
Various methods to mitigate the pain of infiltration have been proposed and employed in practice. Buffering of the local anesthetic solution with sodium bicarbonate is one of the most well-known, but benzyl alcohol, a preservative found in bacteriostatic normal saline, also has been shown to diminish the pain of injections.6,7,8 Additionally, given the continued shortage of local anesthetic, judicious use of available local anesthetic is important and identification of the lowest effective dose is crucial.9 This study examined the pain of infiltration and duration of anesthesia of different anesthetic solutions to find the combination that minimizes the amount of local anesthetic used while maximizing patient comfort.