Local anesthetics in dermatologic surgery: a review of adjuncts and pain reduction techniques

Abstract

A variety of local anesthetic adjuncts exist for dermatological surgery. Similarly, many options to reduce the pain of local anesthesia exist. This review aims to summarise the evidence relating to local anesthetic adjuncts and methods to reduce the pain of local anesthesia. Adjuncts to local anesthetics can be an important consideration to optimise anesthetic effect. Current evidence suggests that buffering and warming local anesthetics, skin cooling, pinching, as well as administering vibrations to the skin are effective at reducing pain during administration. No significant difference was found between administering vibrations and skin cooling with regards to reducing pain. Studies demonstrate that overall, local anesthesia injection into distal sites is safe. However, there remains limited evidence specific to dermatologic surgery supporting ways to reduce pain during local anesthetic injection, and in determining the safety of local anesthetics for distal sites with confidence. Further high-quality research in the form of multi-centre randomised trials is required.