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The Best Review on Local Anaesthesia in Skin Cancer Surgery
If you are doing skin cancer work, you are doing local anaesthesia! This paper provides the best, most up-to-date review on local anaesthesia in skin cancer surgery.
For most GPs the reality is that we use small amounts of lignocaine (or similar) anaesthesia, and it is all very easy and routine. That said, it is always wise to review our practice every now and then:
- As this paper points out, we should avoid using adrenaline with the lignocaine in pregnant women (p 9 and 10).
- Most GPs do not use bicarbonate added to the lignocaine, despite randomised trials showing that this reduces the pain of infiltration (p 11). If you want to be a popular doctor – use bicarb!
- Addition of adrenaline (p 8-10) is shown to be safe, including on ears, nose, digits and penis (despite what we were previously taught).
Although this paper does not consider the risk of delayed, post-op bleeding when we use lignocaine with adrenaline, this risk does exist. If you use this combination, do make sure that the wound is clean and dry when you close, and be ready to tie off any actively bleeding vessels. Many GPs use plain lignocaine in most surgical cases, to avoid this risk – although you need the combination when operating on the lips, and scalp as they bleed so much.