Excision biopsy in a patient with suspected local anaesthetic allergy: use of 0.9% saline with benzyl alcohol as local anaesthesia

Jolliffe, Victoria; Sinclair, Rodney

doi:10.1111/j.1365-2230.2012.04338.x

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…The authors concluded that PS with 1:100,000 epinephrine offers prolonged cutaneous local anaesthesia with less pain than BL1E and offers a good alternative option, especially if patients are allergic to lidocaine. Joliffe and Sinclair [ 31 ] report using PS successfully for an excision biopsy of an atypical forearm naevus in a patient with a previous adverse reaction to local anaesthetic. Lugo-Janer et al [ 32 ] undertook a multi-phase study with phase one very similar to Wilson and Martin [ 30 ], involving volar forearm injections and pinprick testing up to 60 m post-injection [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

Bacteriostatic preserved saline for pain-free periocular injections: review

Hunt

Malhotra

2022

Eye

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We review evidence regarding the use of 0.9% benzyl alcohol in 0.9% sodium chloride solution for periocular injections (‘preserved saline’) including botulinum toxin A injections and local anaesthesia. A literature search was undertaken using search terms ‘bacteriostatic saline’, ‘benzyl-alcohol saline’, ‘benzyl alcohol sodium chloride’ and ‘preserved saline’. Bibliographies identified further sources. There have been 62 studies published on the subject of preserved-saline since 1928. Significantly lower injection-associated pain levels for periocular/facial botulinum toxin injections reconstituted with preserved-saline rather than preservative-free saline are reported by 5 studies. Significantly lower injection-associated pain with preserved-saline diluted lidocaine and epinephrine solution for eyelid anaesthesia compared with unmodified or buffered lidocaine with epinephrine, and adequate anaesthesia, was reported by one study. Thirty-one studies have explored preserved-saline for anaesthetic and seven for bacteriostatic properties, with very low infection rates after periocular botulinum toxin injections, and reduced rates of infection in indwelling catheters when preserved saline is used to flush. A meta-analysis concluded that lidocaine-containing solutions are more effective at reducing pain from insertion of intravenous catheters. Patient-perceived pain related to periorbital injections of local anaesthesia is reduced when the anaesthetic is diluted with benzyl alcohol-preserved saline compared with other dilution or buffering options. Pain is similarly reduced for periocular botulinum toxin injections reconstituted with preserved saline compared with unpreserved saline. Benzyl-alcohol preserved-saline is inexpensive but costlier than unpreserved-saline, with minimal reported complications, particularly with periocular administration, and offers the opportunity to improve the patient experience.

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Section: Methodsmentioning

confidence: 99%

Bacteriostatic preserved saline for pain-free periocular injections: review

Hunt

Malhotra

2022

Eye

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“…2 In addition, 0.9% saline with benzyl alcohol preservative ("bacteriostatic saline") has been used for tumescent anesthesia for both shave and excision biopsies in dermatologic patients with known or suspected allergy to LA. 3 Tumescent infiltration also allows for the administration of higher doses of lidocaine and epinephrine leading to longer-lasting anesthesia across a larger area with less blood loss. 4 This has been used effectively in burns patients undergoing surgical procedures 4 and was found to shorten the surgery duration, reduce postoperative pain, and lessen the development of ecchymosis and erythema in blepharoplasty surgery.…”

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confidence: 99%