Skip to main content
SpringerLink
Log in

Anxiolysis, Anesthesia, and Analgesia

  • Chapter
  • First Online:
Skin Cancer Management

  • 463 Accesses

Abstract

The overwhelming majority of skin cancer surgery is accomplished with local anesthesia, which accounts for some of the safety and cost-effectiveness benefits of clinic-based dermatologic surgery vs. procedures conducted in hospital operating rooms. Pain control is one of the most important components of skin cancer surgery. When done well, it makes the surgical experience much more pleasant for both the patient and the surgeon. Pain control for outpatient procedures requires a holistic approach focusing on more than simply the injection of an anesthetic. These considerations include addressing patient pre- and intraoperative anxiety, knowledge of local anesthetics and their additives, skill with appropriate injection techniques to reduce patient discomfort, and the ability to anticipate and address analgesia following the procedure and will be covered in this chapter.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zbar RIS. Identifying and managing those patients at risk for aborted Mohs micrographic surgery. Ann Plast Surg. 2012;68(1):67–71. https://doi.org/10.1097/SAP.0b013e31821150e9.

    Article  CAS  PubMed  Google Scholar 

  2. Chen AF, Landy DC, Kumetz E, Smith G, Weiss E, Saleeby ER. Prediction of postoperative pain after Mohs micrographic surgery with 2 validated pain anxiety scales. Dermatologic Surg. 2015;41(1):40–7. https://doi.org/10.1097/DSS.0000000000000224.

    Article  CAS  Google Scholar 

  3. Neal DE, Feit EM, Etzkorn JR. Patient preferences for the treatment of basal cell carcinoma. Dermatol Surg. 2018;44(8):1. https://doi.org/10.1097/DSS.0000000000001564.

    Article  CAS  Google Scholar 

  4. Golda N, Beeson S, Kohli N, Merrill B. Recommendations for improving the patient experience in specialty encounters. J Am Acad Dermatol. 2018;78(4):653–9. https://doi.org/10.1016/j.jaad.2017.05.040.

    Article  PubMed  Google Scholar 

  5. Sobanko JF, Da Silva D, Chiesa Fuxench ZC, et al. Preoperative telephone consultation does not decrease patient anxiety before Mohs micrographic surgery. J Am Acad Dermatol. 2017;76(3):519–26. https://doi.org/10.1016/j.jaad.2016.09.027.

    Article  PubMed  Google Scholar 

  6. Vachiramon V, Sobanko JF, Rattanaumpawan P, Miller CJ. Music reduces patient anxiety during Mohs surgery: an open-label randomized controlled trial. Dermatol Surg. 2013;39(2):298–305. https://doi.org/10.1111/dsu.12047.

    Article  CAS  PubMed  Google Scholar 

  7. Alam M, Roongpisuthipong W, Kim NA, et al. Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: a single-blinded randomized controlled trial. J Am Acad Dermatol. 2016;75(3):585–9. https://doi.org/10.1016/j.jaad.2016.02.1143.

    Article  PubMed  Google Scholar 

  8. Yanes AF, Weil A, Furlan KC, Poon E, Alam M. Effect of stress ball use or hand-holding on anxiety during skin cancer excision: a randomized clinical trial. JAMA Dermatol. 2018;154(9):1045–9. https://doi.org/10.1001/jamadermatol.2018.1783.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Abeles G, Warmuth IP, Sequeira M, Swensen RD, Bisaccia E, Scarborough DA. The use of conscious sedation for outpatient dermatologic surgical procedures. Dermatol Surg. 2000;26(2):121–6. https://doi.org/10.1046/j.1524-4725.2000.98224.x.

    Article  CAS  PubMed  Google Scholar 

  10. Brotzman EA, Sandoval LF, Crane J. Use of nitrous oxide in dermatology. Dermatol Surg. 2018;44(5):1. https://doi.org/10.1097/DSS.0000000000001464.

    Article  CAS  Google Scholar 

  11. Ravitskiy L, Phillips PK, Roenigk RK, et al. The use of oral midazolam for perioperative anxiolysis of healthy patients undergoing Mohs surgery: conclusions from randomized controlled and prospective studies. J Am Acad Dermatol. 2011;64(2):310–22. https://doi.org/10.1016/j.jaad.2010.02.038.

    Article  CAS  PubMed  Google Scholar 

  12. Donaldson M, Gizzarelli G, Chanpong B. Oral sedation: a primer on anxiolysis for the adult patient. Anesth Prog. 2007;54(3):118–28; quiz 129. https://doi.org/10.2344/0003-3006(2007)54[118:OSAPOA]2.0.CO;2.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Coldwell SE, Milgrom P, Getz T, Ramsay DS. Amnestic and anxiolytic effects of alprazolam in oral surgery patients. J Oral Maxillofac Surg. 1997;55(10):1061–70.

    Article  CAS  PubMed  Google Scholar 

  14. Koay J, Orengo I. Application of local anesthetics in dermatologic surgery. Dermatol Surg. 2002;28(2):143–8.

    PubMed  Google Scholar 

  15. McLure HA, Rubin AP. Review of local anaesthetic agents. Minerva Anestesiol. 2005;71(3):59–74.

    CAS  PubMed  Google Scholar 

  16. Eggleston ST, Lush LW. Understanding allergic reactions to local anesthetics. Ann Pharmacother. 1996;30(7–8):851–7. https://doi.org/10.1177/106002809603000724.

    Article  CAS  PubMed  Google Scholar 

  17. Malamed SF. Handbook of local anesthesia. 4th ed. St. Louis: Mosby; 1997.

    Google Scholar 

  18. Jackson D, Chen AH, Bennett CR. Identifying true lidocaine allergy. J Am Dent Assoc. 1994;125(10):1362–6.

    Article  CAS  PubMed  Google Scholar 

  19. Friedman PM, Mafong EA, Friedman ES, Geronemus RG. Topical anesthetics update: EMLA and beyond. Dermatol Surg. 2001;27(12):1019–26.

    CAS  PubMed  Google Scholar 

  20. Cohen MJ, Schecter WP. Perioperative pain control: a strategy for management. Surg Clin North Am. 2005;85(6):1243–57, xi. https://doi.org/10.1016/j.suc.2005.09.009.

    Article  PubMed  Google Scholar 

  21. Bartfield JM, Holmes TJ, Raccio-Robak N. A comparison of proparacaine and tetracaine eye anesthetics. Acad Emerg Med. 1994;1(4):364–7.

    Article  CAS  PubMed  Google Scholar 

  22. Harper SJ, Jones NS. Cocaine: what role does it have in current ENT practice? A review of the current literature. J Laryngol Otol. 2006;120(10):808–11. https://doi.org/10.1017/S0022215106001459.

    Article  CAS  PubMed  Google Scholar 

  23. Lee HJ, Cho YJ, Gong HS, Rhee SH, Park HS, Baek GH. The effect of buffered lidocaine in local anesthesia: a prospective, randomized, double-blind study. J Hand Surg Am. 2013;38(5):971–5. https://doi.org/10.1016/j.jhsa.2013.02.016.

    Article  PubMed  Google Scholar 

  24. Gresham KA, Carroll BT. A simple elastomer-pad vibratory dampener to maximize pain control of injections in patientʼs undergoing dermatological surgery. Dermatol Surg. 2016;42(6):788–90. https://doi.org/10.1097/DSS.0000000000000718.

    Article  CAS  PubMed  Google Scholar 

  25. Dixit S, Lowe P, Fischer G, Lim A. Ice anaesthesia in procedural dermatology. Australas J Dermatol. 2013;54(4):273–6. https://doi.org/10.1111/ajd.12057.

    Article  PubMed  Google Scholar 

  26. Kouba DJ, LoPiccolo MC, Alam M, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016;74(6):1201–19. https://doi.org/10.1016/j.jaad.2016.01.022.

    Article  PubMed  Google Scholar 

  27. Goulet JP, Pérusse R, Turcotte JY. Contraindications to vasoconstrictors in dentistry: part III. Pharmacologic interactions. Oral Surg Oral Med Oral Pathol. 1992;74(5):692–7.

    Article  CAS  PubMed  Google Scholar 

  28. Yagiela JA. Adverse drug interactions in dental practice: interactions associated with vasoconstrictors. Part V of a series. J Am Dent Assoc. 1999;130(5):701–9.

    Article  CAS  PubMed  Google Scholar 

  29. Yagiela JA. Pharmacology and therapeutics for dentistry. St. Louis: Mosby Elsevier; 2011.

    Google Scholar 

  30. Budenz AW. Local anesthetics and medically complex patients. J Calif Dent Assoc. 2000;28(8):611–9.

    Article  CAS  PubMed  Google Scholar 

  31. Dzubow LM. The interaction between propranolol and epinephrine as observed in patients undergoing Mohs’ surgery. J Am Acad Dermatol. 1986;15(1):71–5.

    Article  CAS  PubMed  Google Scholar 

  32. McKee DE, Lalonde DH, Thoma A, Glennie DL, Hayward JE. Optimal time delay between epinephrine injection and incision to minimize bleeding. Plast Reconstr Surg. 2013;131(4):811–4. https://doi.org/10.1097/PRS.0b013e3182818ced.

    Article  CAS  PubMed  Google Scholar 

  33. Stewart JH, Chinn SE, Cole GW, Klein JA. Neutralized lidocaine with epinephrine for local anesthesia–II. J Dermatol Surg Oncol. 1990;16(9):842–5.

    Article  CAS  PubMed  Google Scholar 

  34. Stewart JH, Cole GW, Klein JA. Neutralized lidocaine with epinephrine for local anesthesia. J Dermatol Surg Oncol. 1989;15(10):1081–3.

    Article  CAS  PubMed  Google Scholar 

  35. Larson PO, Ragi G, Swandby M, Darcey B, Polzin G, Carey P. Stability of buffered lidocaine and epinephrine used for local anesthesia. J Dermatol Surg Oncol. 1991;17(5):411–4.

    Article  CAS  PubMed  Google Scholar 

  36. Alam M, Waldman A. Commentary on safety of prefilled buffered lidocaine syringes with and without epinephrine. Dermatol Surg. 2016;42(3):366–7. https://doi.org/10.1097/DSS.0000000000000667.

    Article  CAS  PubMed  Google Scholar 

  37. State department of health – Health systems quality assurance – Construction review services W. USP pharmaceutical compounding –Sterile preparations; 2008. https://www.sefh.es/fichadjuntos/USP797GC.pdf. Accessed 30 Apr 2020.

  38. Hruza G. Dermatology. In: Bolognia J, Schaffer JV, Cerroni L, editors. Dermatology. 1st ed. St. Louis: Mosby; 2008. p. 2674.

    Google Scholar 

  39. Allen WJ, Barcroft H, Edholm OG. On the action of adrenaline on the blood vessels in human skeletal muscle. J Physiol. 1946;105(3):255–67.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Davies T, Karanovic S, Shergill B. Essential regional nerve blocks for the dermatologist: part 1. Clin Exp Dermatol. 2014;39(7):777–84. https://doi.org/10.1111/ced.12427.

    Article  CAS  PubMed  Google Scholar 

  41. Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16(3):248–63.

    Article  CAS  PubMed  Google Scholar 

  42. Ramirez OM, Galdino G. Does tumescent infiltration have a deleterious effect on undermined skin flaps? Plast Reconstr Surg. 1999;104(7):2269–72; discussion 2273–7.

    Article  CAS  PubMed  Google Scholar 

  43. Sniezek PJ, Brodland DG, Zitelli JA. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after Mohs surgery and cutaneous reconstruction. Dermatol Surg. 2011;37(7):1007–13. https://doi.org/10.1111/j.1524-4725.2011.02022.x.

    Article  CAS  PubMed  Google Scholar 

  44. Sobanko JF, Miller CJ, Alster TS. Topical anesthetics for dermatologic procedures: a review. Dermatol Surg. 2012;38(5):709–21. https://doi.org/10.1111/j.1524-4725.2011.02271.x.

    Article  CAS  PubMed  Google Scholar 

  45. Marra DE, Yip D, Fincher EF, Moy RL. Systemic toxicity from topically applied lidocaine in conjunction with fractional photothermolysis. Arch Dermatol. 2006;142(8):1024–6. https://doi.org/10.1001/archderm.142.8.1024.

    Article  CAS  PubMed  Google Scholar 

  46. Speca SJ, Boynes SG, Cuddy MA. Allergic reactions to local anesthetic formulations. Dent Clin N Am. 2010;54(4):655–64. https://doi.org/10.1016/j.cden.2010.06.006.

    Article  PubMed  Google Scholar 

  47. Park KK, Sharon VR. A review of local anesthetics. Dermatol Surg. 2017;43(2):173–87. https://doi.org/10.1097/DSS.0000000000000887.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Missouri School of Medicine, Department of Dermatology, Columbia, MO, USA

    Nicholas J. Golda

  2. Collier Skin Cancer Center, Oklahoma City, OK, USA

    Susannah Lambird Collier

  3. Laser and Dermatologic Surgery Center, Chesterfield, MO, USA

    George J. Hruza

  4. St. Louis University School of Medicine, St. Louis, MO, USA

    George J. Hruza

Authors
  1. Nicholas J. Golda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susannah Lambird Collier
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George J. Hruza
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicholas J. Golda .

Editor information

Editors and Affiliations

  1. Departments of Dermatology and Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Deborah F. MacFarlane

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Golda, N.J., Collier, S.L., Hruza, G.J. (2021). Anxiolysis, Anesthesia, and Analgesia. In: MacFarlane, D.F. (eds) Skin Cancer Management. Springer, Cham. https://doi.org/10.1007/978-3-030-50593-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-50593-6_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-50592-9

  • Online ISBN: 978-3-030-50593-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation