Risk analysis of systemic side effects of tumescent local anaesthesia in the surgical treatment of geriatric and multimorbid patients with skin cancer

Abstract

Background: Due to demographic change and increased UV exposure, the number of dermatosurgical procedures in the elderly is increasing. Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive. Objectives:The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia.Methods: Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the

Tumescent local anesthesia in geriatric patients with head and neck skin cancer – a retrospective study of 782 patients

“…Although TLA is widely used in dermatosurgery, [11][12][13] data on geriatric and multimorbid patients is limited. 15 Clinical advantages of TLA described in the literature should be of particular benefit to these patients. To the best of our knowledge, due to the large number of patients (n = 782) and the large number of interventions (n = 2940), this is the first and most comprehensive study that has investigated inpatient SCS with TLA in elderly patients.…”

“…35 A short inpatient stay is the result of performing procedures in TLA on consecutive days without major organizational effort (e.g. separate appointment for preoperative anesthesia consultation, necessary accompaniment) and without the risks of GA. [12][13][14][15]33,36,37 This fully utilizes the advantages of three-dimensional histology with an available histology result after 20 hours, tissue-saving surgery and high patient satisfaction. 8,16 In comparison to conventional use of LA, 5 the diffusion of large amounts of tumescent solution in the tissue enables anesthesia of large areas and thus surgery of large and deep infiltrating tumors as well as more complex reconstructions.…”

“…2 Tumescent local anesthesia (TLA) involves the infiltration of a diluted solution of different long-acting local anesthetics (LA) and an epinephrine additive into the subcutaneous tissue, 9 is well established, [10][11][12][13] and considered to be safe. [13][14][15] Major interventions, such as large tumor excisions and complex reconstructions, can be performed, 14,16,17 and elderly patients in particular should benefit from the clinical advantages described, such as reduced intraoperative blood flow and prolonged postoperative analgesia. 10,14 There is limited data on dermatosurgery in elderly patients in general.…”

“…10,14 There is limited data on dermatosurgery in elderly patients in general. [15][16][17][18][19][20][21][22][23][24][25] More precise data, specifically on the use of TLA, is lacking. The aim of this study was to investigate TLA in geriatric and multimorbid patients with head and neck (H&N) SCS.…”

Tumeszenz‐Lokalanästhesie bei geriatrischen Patienten mit Hauttumoren im Kopf‐Hals‐Bereich – Eine retrospektive Studie an 782 Patienten

“…2 Die Tumeszenz-Lokalanästhesie (TLA), bei der eine verdünnte Lösung verschiedener langwirksamer Lokalanästhetika (LA) mit Epinephrin-Zusatz in das subkutane Gewebe infiltriert wird, 9 ist gut etabliert [10][11][12][13] und gilt als sicher. [13][14][15] Größere Eingriffe wie zum Beispiel große Tumorexzisionen und komplexe Rekonstruktionen können durchgeführt werden 14,16,17 und besonders ältere Patienten sollten von den beschriebenen klinischen Vorteilen, wie zum Beispiel reduzierter intraoperativer Blutfluss und verlängerte postoperative Analgesie, profitieren. 10,14 Generell gibt es nur wenige Daten über dermatochirurgische Eingriffe bei älteren Patienten.…”