Post‐operative follow‐up of 150 patients with sentinel lymph node biopsy under tumescence local anesthesia

Abstract

Background: Sentinel lymph node biopsy (SLNB) is useful for staging of patients with melanoma. Although SLNB is mostly performed under general anesthesia (GA), tumescence local anesthesia (TLA) can also be used. However, less data are available regarding feasibility of SLNB under TLA. Here we present a post-operative follow-up of 150 patients. Patients and Methods:We prospectively analyzed data from 150 patients with primary cutaneous malignant melanoma. We assessed pain, post-operative complications and patients' satisfaction after SLNB under TLA.Results: 32 % of the patients reported post-operative pain within the first 48 h after SLNB. Seroma was the most frequent complication, as 29 seromas after SLNB were observed. Wound infection was observed in 3.3 % of the patients. 98.7 % of the patients were satisfied with SLNB under TLA.Conclusions: SLNB under TLA is a safe and feasible option and should be considered for patients with melanoma. Especially with multimorbid or elderly patients, the risks of GA can be avoided.

Telephone follow‐up for monitoring of complications and boosting patient satisfaction after inpatient dermatosurgery: a prospective two‐center study

“…Especially, the rates of postoperative wound infections (6.1 %) and graft necrosis (9.2 %) in our study were comparable to the rates already reported in the literature [23][24][25]. Also, the developement of seroma after a sentinel lymph node biobsy was identified in 10.9 % of the patients using TFU, that was similar to the previously described data for this complication (10.1 %) [26]. Overall, this confirms that TFU is an effective method for detecting postoperative complications.…”

Impact of anesthesia choice in cutaneous melanoma surgery

“…Typically, the tipping point where a general anesthesia is considered in the context of a sentinel or index lymph node biopsy. However, lymph node biopsy under either local or tumescent local anesthesia is a well-described and tolerated procedure, resulting in statistically equivalent lymph node harvests, shorter operating time and costs, and no difference in complication rates [75,76]. In addition, these less systematic options are safer for the elderly or patients with advanced comorbidities [76].…”

“…However, lymph node biopsy under either local or tumescent local anesthesia is a well-described and tolerated procedure, resulting in statistically equivalent lymph node harvests, shorter operating time and costs, and no difference in complication rates [75,76]. In addition, these less systematic options are safer for the elderly or patients with advanced comorbidities [76]. A recent report of 204 elderly patients undergoing melanoma surgical treatment, including sentinel lymph node biopsy under local anesthesia with median age of 75.7 years, reported no need to switch to a general anesthesia or limit procedure due to insufficient local anesthesia [77].…”

Perioperative pain management in dermatosurgery – current practice in Germany: Data analysis of a Germany‐wide online survey among dermatosurgeons

“…Julia Eckardt et al showed in their study that even after lymph node biopsies under local anesthesia, only a small proportion of patients (17.3%) requested pain medication. 17 A systematic review by Saco and Golda found that the overall TA B L E 3 The PQRST system. 12 P -Provocation (What triggers the pain?)…”