• Murad Alam, Matthew R Schaeffer, Amelia Geisler, Emily Poon, Scott W Fosko, and Divya Srivastava.
• 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.
• Dermatol Surg. 2016 Dec 1; 42 (12): 1320-1324.

BackgroundIntracutaneous lidocaine is used for anesthesia in dermatologic surgery for skin cancer excision and repair with exceedingly low incidence of reported adverse events.ObjectiveTo 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.MethodsSurvey 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.ResultsA 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.ConclusionToxicity 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.

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