C J Porter1, F A Frizelle. 1. Department of Plastic & Reconstructive Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand.
Abstract
PURPOSE: Skin lesions are treated by a variety of medical practitioners. To describe the method and techniques of use of local anaesthetic (LA) for excision of skin lesions amongst a group of surgeons who are frequent users. METHODS: An open-ended questionnaire was designed to investigate the way LA was used for local excision and reasons behind the practice. All registered Plastic and Reconstructive Surgeons in New Zealand were sent the questionnaire. This group was chosen because they are high frequency users of local anaesthetic for excision of skin lesions. RESULTS: Questionnaires were sent to all 28 Plastic and Reconstructive Surgeons in New Zealand of which twenty-three (82%) responded. The reasons for selection of specific products relate to convenience of product (14), speed of onset (6), effect duration (4), ease to add bicarbonate (3), others (5). Lignocaine and bupivicaine were the most popular LA agent used except when there was concern about cardiac toxicity when Prilocaine was used instead. Adrenaline was used for vasoconstriction induced haemostasis, and avoided in anatomical areas with end arteries due to the risk of tissue ischaemia. This complication was identified as medicolegally indefensible despite a lack of scientific evidence in the literature. The techniques used to reduce patient discomfort of local anaesthetic infiltration relate to patient oriented techniques (15), injection related techniques (25), LA agent related techniques (19). Details of these specific techniques are presented in detail. CONCLUSIONS: LA uses vary according to the specific surgical situation, patient risk factors and according to the individual surgeon. The main reason for selection of a specific LA agent relates to convenience and not pharmacokinetics. Injection related techniques are the most common method to reduce pain from LA.
PURPOSE:Skin lesions are treated by a variety of medical practitioners. To describe the method and techniques of use of local anaesthetic (LA) for excision of skin lesions amongst a group of surgeons who are frequent users. METHODS: An open-ended questionnaire was designed to investigate the way LA was used for local excision and reasons behind the practice. All registered Plastic and Reconstructive Surgeons in New Zealand were sent the questionnaire. This group was chosen because they are high frequency users of local anaesthetic for excision of skin lesions. RESULTS: Questionnaires were sent to all 28 Plastic and Reconstructive Surgeons in New Zealand of which twenty-three (82%) responded. The reasons for selection of specific products relate to convenience of product (14), speed of onset (6), effect duration (4), ease to add bicarbonate (3), others (5). Lignocaine and bupivicaine were the most popular LA agent used except when there was concern about cardiac toxicity when Prilocaine was used instead. Adrenaline was used for vasoconstriction induced haemostasis, and avoided in anatomical areas with end arteries due to the risk of tissue ischaemia. This complication was identified as medicolegally indefensible despite a lack of scientific evidence in the literature. The techniques used to reduce patient discomfort of local anaesthetic infiltration relate to patient oriented techniques (15), injection related techniques (25), LA agent related techniques (19). Details of these specific techniques are presented in detail. CONCLUSIONS: LA uses vary according to the specific surgical situation, patient risk factors and according to the individual surgeon. The main reason for selection of a specific LA agent relates to convenience and not pharmacokinetics. Injection related techniques are the most common method to reduce pain from LA.