A Review of Local Anesthetics: Minimizing Risk and Side Effects in Cutaneous Surgery

Abstract

Local anesthetics commonly used in cutaneous surgery have potential risks and side effects. Appropriate selection and utilization of local anesthetics and knowledge of the means to prevent and address these risks can impact surgical outcomes, patient satisfaction and safety, and ultimately patient experience in the dermatology clinic.

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

“…In our practice, surgeons are reluctant to give lidocaine without previous dosage calculation, especially to top up regional blocks with WI. All agents are safe if we respect recommended dosing "using the lowest concentration and dose necessary for analgesia" (Table 1) [37,55,[57][58][59][60][61]. The rate of systemic LA absorption differs between injection sites due to vascularity of the area and tissue binding of LA [62].…”

Local anesthetics for the Nephrologist

“…In a hyperdynamic circulation, the increased blood flow coupled with increased uptake can result in high peak plasma concentrations that may be achieved earlier compared with patients with normal kidney function. Additionally, impaired kidney function also leads to a decrease in the clearance of metabolites of LAs that are eliminated by the kidneys [ 12 , 13 ]. Thus, the LA peak effect, and their metabolites may accumulate during prolonged infusion [ 14 ].…”

“…Usually, kidney dysfunction does not increase the risk of LA toxicity, unless metabolic derangements including acidosis, hypoxia or hypercarbia are present. The hyperdynamic circulation in uremic patients causes a rapid rise in LAs plasma levels after large volume nerve block, however the levels of free drug in circulation are low, due to greater protein binding to AAG, which is an acute-phase reactant and is increased in this subset of patients [ 12 ]. Therefore, the overall risk of LA systemic toxicity remains low.…”

Gelatin/Cellulose nanowhiskers hydrogels intended for the administration of drugs in dental treatments: Study of lidocaine as model case

“…Between them incomplete anaesthesia doses, the occurrence of needle phobia, the bleeding or hematoma formation and other serious systemic complications are frequently found [5]. Toward overcoming these limitations, pharmaceutical research is advancing in the formulation of novel devices that safely prolong and enhance the anaesthetic effect at the site of administration involving less invasive procedures [6].…”