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

      Gnanappiragasam, Dushyanth; Veitch, David; Wernham, Aaron (2022-05-27)
      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.
    • A multicentre qualitative study of patient skin surgery experience during the COVID-19 pandemic in the UK

      Gnanappiragasam, Dushyanth; Veitch, David; Wernham, Aaron
      Understanding patient concerns regarding skin surgery during the COVID-19 pandemic is a vital way of learning from individual experiences. A shift towards using superficial absorbable sutures (AS) has been anecdotally observed. We explored patient attitudes to the use of AS, and their experiences and perceptions of attending for skin surgery during the pandemic. In total, 35 participants were interviewed (74% men, 100% white British; mean age 72.5 years, range 43-95 years). Participants reported that they were reassured by precautions taken to minimize exposure and risk from COVID-19. The majority (86%) did not feel that personal protective equipment worn by staff impaired their experience, and 29% reported that their experience of attending for skin surgery during the lockdown period was more efficient and organized than on prepandemic visits. The vast majority (94%) of participants would opt to have AS again or had no strong preference for either suture type. Based on their experiences, most participants would have no concerns about attending for further skin surgery during the pandemic and would opt to have AS.