title: Safety of Local Intracutaneous Lidocaine Anesthesia Used by Dermatologic Surgeons for Skin Cancer Excision and Postcancer Reconstruction: Quantification of Standard Injection Volumes and Adverse Event Rates.
abstract: BACKGROUND
  Intracutaneous lidocaine is used for anesthesia in dermatologic surgery for skin cancer excision and repair with exceedingly low incidence of reported adverse events.
  
  
  OBJECTIVE
  To measure (1) the quantity of lidocaine typically used for facial skin cancer excision and reconstruction; and (2) the frequency and character of associated adverse events.
  
  
  METHODS
  Survey study of dermatologic surgeons with longitudinal reporting. Reported practice during 10 business days: (1) mean volume of 1% lidocaine per skin cancer excision; (2) maximum per excision; (3) mean per reconstruction; and (4) maximum per reconstruction.
  
  
  RESULTS
  A total of 437 of 1,175 subjects contacted (37.2%) responded. Mean per excision was 3.44 mL (SD: 2.97), and reconstruction 11.70 mL (10.14). Maximum per excision was 6.54 mL (4.23), and reconstruction was 15.85 mL (10.39). No cases of lidocaine toxicity were reported, diagnosed, or treated. Incidence of adverse events possibly anesthesia related was >0.15%, with most (0.13%) being mild cases of dizziness, drowsiness, or lightheadedness from epinephrine tachycardia.
  
  
  CONCLUSIONS
  Toxicity associated with local anesthesia other than lidocaine was not studied. Volumes of lidocaine in skin cancer excision and repair are modest and within safe limits. Lidocaine toxicity is exceedingly rare to entirely absent. For comparable indications, lidocaine is safer than conscious sedation or general anesthesia.
authors.affiliation: Departments of *Dermatology,†Otolaryngology, and‡Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;§Department of Dermatology, Mayo Clinic, Jacksonville, Florida;‖Department of Dermatology, UT Southwestern Medical Center, Dallas, Texas;¶Department of Dermatology, Saint Louis University School of Medicine, Saint Louis University, St. Louis, Missouri.
authors.forename: Murad
authors.initials: M
authors.lastname: Alam
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Schaeffer
authors.forename: Amelia
authors.initials: A
authors.lastname: Geisler
authors.forename: Emily
authors.initials: E
authors.lastname: Poon
authors.forename: Scott W
authors.initials: SW
authors.lastname: Fosko
authors.forename: Divya
authors.initials: D
authors.lastname: Srivastava
mesh_terms: D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D003430:Cross-Sectional Studies; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007271:Injections, Intradermal; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects; D008137:Longitudinal Studies; D015580:Mohs Surgery; D061214:Patient Safety; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019651:Plastic Surgery Procedures; D012878:Skin Neoplasms / Q000601:surgery*; D014481:United States
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine