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J Am Acad Dermatol. 2009 Mar;60(3):444-52. doi: 10.1016/j.jaad.2008.08.001.

A randomized, double-blind comparison of the total dose of 1.0% lidocaine with 1:100,000 epinephrine versus 0.5% lidocaine with 1:200,000 epinephrine required for effective local anesthesia during Mohs micrographic surgery for skin cancers.

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  • 1Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.

Abstract

OBJECTIVE:

We sought to compare total lidocaine dose and patient comfort when using 1.0% lidocaine with 1:100,000 epinephrine versus 0.5% lidocaine with 1:200,000 epinephrine during Mohs micrographic surgery.

METHODS:

In all, 149 patients were randomized to receive 1.0% lidocaine with 1:100,000 epinephrine or 0.5% lidocaine with 1:200,000 epinephrine during Mohs micrographic surgery. The total dose of lidocaine and measures of patient comfort were recorded.

RESULTS:

Compared with the 1.0% lidocaine group, there was a 52% reduction in lidocaine dose in the 0.5% group (mean difference, 147.85 mg; 95% confidence interval, 108.15-187.55; P < .001). Patient comfort was equivalent in both groups, as evidenced by the similar mean visual analog scale scores (P = .48) and mean volumes of rescue lidocaine administered (P = .18).

LIMITATIONS:

No lidocaine blood levels were measured, and one Mohs surgeon performed all surgeries.

CONCLUSION:

The dose of 0.5% lidocaine with 1:200,000 epinephrine provides pain control equivalent to 1.0% lidocaine with 1:100,000 epinephrine at approximately half the total lidocaine dose.

PMID:
19231641
[PubMed - indexed for MEDLINE]
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