A randomized, double-blind comparison of the total dose of 1.0% lidocaine with 1:100,000 epinephrine versus 0.5% lidocaine with 1:200,000 epinephrine required for effective local anesthesia during Mohs micrographic surgery for skin cancers.
OBJECTIVE
We sought to compare total lidocaine dose and patient comfort when using 1.0% lidocaine with 1:100,000 epinephrine versus 0.5% lidocaine with 1:200,000 epinephrine during Mohs micrographic surgery.


METHODS
In all, 149 patients were randomized to receive 1.0% lidocaine with 1:100,000 epinephrine or 0.5% lidocaine with 1:200,000 epinephrine during Mohs micrographic surgery. The total dose of lidocaine and measures of patient comfort were recorded.


RESULTS
Compared with the 1.0% lidocaine group, there was a 52% reduction in lidocaine dose in the 0.5% group (mean difference, 147.85 mg; 95% confidence interval, 108.15-187.55; P < .001). Patient comfort was equivalent in both groups, as evidenced by the similar mean visual analog scale scores (P = .48) and mean volumes of rescue lidocaine administered (P = .18).


CONCLUSIONS
No lidocaine blood levels were measured, and one Mohs surgeon performed all surgeries.


CONCLUSIONS
The dose of 0.5% lidocaine with 1:200,000 epinephrine provides pain control equivalent to 1.0% lidocaine with 1:100,000 epinephrine at approximately half the total lidocaine dose.
Morganroth
Pamela A
PA
Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
Gelfand
Joel M
JM
Jambusaria
Anokhi
A
Margolis
David J
DJ
Miller
Christopher J
CJ
D000368:Aged; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control; D017060:Patient Satisfaction; D012878:Skin Neoplasms / Q000601:surgery*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D004837:Epinephrine