Benefits, safety and side effects of tumescent local anesthesia in dermatologic surgery in infants

Abstract

Summary Tumescent local anesthesia (TLA) plays an important role in dermatosurgical procedures. TLA has several benefits such as long‐lasting anesthesia, reduced bleeding during surgery and the avoidance of general anesthesia‐associated complications. Convenience and a favorable risk profile along with a broad spectrum of indications are further reasons why TLA is increasingly applied in infants as well. There are not only a variety of indications for surgical excisions in infancy, such as congenital nevi, but also substantial benefits when performing these excisions at an early age. These include the smaller size of the lesions as well as the unproblematic wound healing and tissue regeneration in infancy. Nevertheless, several aspects need to be considered when applying TLA in infants including dosing, altered plasma protein binding and the need for adequate and long‐lasting pain control.

Tumescent local anaesthesia for the surgical therapy of congenital nevi in the first year of life

“…Performing procedures under TLA is also safe in young children, taking into account important principles of safety and adherence to volume maxima, and expands the surgical spectrum at this age. 7 Serial excisions in children with congenital nevi at a very early age allow to take advantage of the typically stretchable skin and good wound healing abilities of infants (Figure 5). 4,5 Typically, elective surgery is not performed in GA during the first year of life to reduce the risk for GA-related developmental delays or complications.…”

“…TLA can also be performed well in the first months of life with the appropriate experience and surgical setting and allows to perform surgery of congenital nevi without general anaesthesia. 7 Little is known about the effect of general anaesthesia in the first year of life on neurological development. However, there is evidence that surgery under 4 years of age under general anaesthesia might have a negative effect on later academic and cognitive performance.…”

Surgical therapy of congenital nevi using power‐stretching technique on the forehead

“…This depends on the wound tension and the cooperation of the child and parents. Rörden et al could show that the use of TLA is also safe in young children with the corresponding indication [10] with consideration given to maximum amounts used (12 ml/kg body weight [bw] [at 0.05% TLA] [6]). From a school age onward, interventions under TLA are again readily feasible.…”

Operative Therapie kongenitaler Nävi mittels Power‐Stretching‐Technik an der Stirn

“…Dies hängt von der Wundspannung und der Mitarbeit des Kindes und der Eltern ab. Rörden et al konnten zeigen, dass die Anwendung von TLA auch bei Kleinkindern mit entsprechender Indikationsstellung und Rücksicht auf maximal verwendete Mengen (12 ml/kg Körpergewicht [KG] [bei 0,05 % TLA] [6]) sicher möglich ist [10]. Ab dem Schulalter sind Eingriffe in TLA wieder gut durchführbar.…”