title: Assessment of intraoperative pain during Mohs micrographic surgery (MMS): An opportunity for improved patient care.
abstract: BACKGROUND
  Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, many patients report postoperative pain on the day of MMS.
  
  
  OBJECTIVE
  We sought to determine if patients experience pain during their MMS visit.
  
  
  METHODS
  In phase I of this study, patients were asked to report intraoperative pain level using the verbal numerical rating scale (0-10) at discharge. In phase II, pain levels were assessed before each Mohs layer and at discharge, to determine whether pain was experienced throughout the day.
  
  
  RESULTS
  Pain was reported at some point during the MMS day for 32.8% of patients (n = 98). The mean pain number reported was 3.7 (range 1-8) out of 10. Pain was more commonly reported by patients who spent a longer time in the office, had 3 or more Mohs layers, and had a flap or graft repair. Patients most frequently reported pain with surgical sites of the periorbital area and nose.
  
  
  CONCLUSIONS
  Time between Mohs layers was not measured. There was nonstandardized use of intraoperative local anesthesia volume and oral pain medications.
  
  
  CONCLUSIONS
  Some patients experience pain during MMS. However, the majority of patients report a low level of pain. Additional preventative measures could be considered in patients at higher risk.
authors.affiliation: Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Connolly
authors.affiliation: Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Kishwer S
authors.initials: KS
authors.lastname: Nehal
authors.affiliation: Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Dusza
authors.affiliation: Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Rossi
authors.affiliation: Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York. Electronic address: leee@mskcc.org.
authors.forename: Erica H
authors.initials: EH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000009:adverse effects* / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D016017:Odds Ratio; D061646:Operative Time; D010146:Pain / Q000175:diagnosis* / Q000209:etiology; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000503:physiopathology; D005791:Patient Care / Q000379:methods*; D010865:Pilot Projects; D058996:Quality Improvement; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Mohs micrographic surgery; intraoperative pain; verbal numerical rating scale-11