Porter C J, Frizelle F A
Department of Plastic & Reconstructive Surgery, Christchurch Hospital, Riccarton Ave, Christchurch, New Zealand.
Med Sci Monit. 2000 Jan-Feb;6(1):194-7.
Skin lesions are treated by a variety of medical practitioners. To describe the method and techniques of use of local anaesthetic (LA) for excision of skin lesions amongst a group of surgeons who are frequent users.
An open-ended questionnaire was designed to investigate the way LA was used for local excision and reasons behind the practice. All registered Plastic and Reconstructive Surgeons in New Zealand were sent the questionnaire. This group was chosen because they are high frequency users of local anaesthetic for excision of skin lesions.
Questionnaires were sent to all 28 Plastic and Reconstructive Surgeons in New Zealand of which twenty-three (82%) responded. The reasons for selection of specific products relate to convenience of product (14), speed of onset (6), effect duration (4), ease to add bicarbonate (3), others (5). Lignocaine and bupivicaine were the most popular LA agent used except when there was concern about cardiac toxicity when Prilocaine was used instead. Adrenaline was used for vasoconstriction induced haemostasis, and avoided in anatomical areas with end arteries due to the risk of tissue ischaemia. This complication was identified as medicolegally indefensible despite a lack of scientific evidence in the literature. The techniques used to reduce patient discomfort of local anaesthetic infiltration relate to patient oriented techniques (15), injection related techniques (25), LA agent related techniques (19). Details of these specific techniques are presented in detail.
LA uses vary according to the specific surgical situation, patient risk factors and according to the individual surgeon. The main reason for selection of a specific LA agent relates to convenience and not pharmacokinetics. Injection related techniques are the most common method to reduce pain from LA.
多种医学从业者都可治疗皮肤损伤。本研究旨在描述一组经常进行皮肤损伤切除手术的外科医生使用局部麻醉剂（LA）的方法和技巧。
设计一份开放式问卷，以调查LA用于局部切除的方式及相关操作背后的原因。向新西兰所有注册的整形与重建外科医生发送问卷。选择这一群体是因为他们在皮肤损伤切除手术中频繁使用局部麻醉剂。
向新西兰所有28位整形与重建外科医生发送了问卷，其中23位（82%）回复。选择特定产品的原因涉及产品便利性（14例）、起效速度（6例）、作用持续时间（4例）、添加碳酸氢盐的难易程度（3例）、其他（5例）。除了担心心脏毒性而改用丙胺卡因外，利多卡因和布比卡因是最常用的LA药物。肾上腺素用于血管收缩诱导的止血，由于存在组织缺血风险，在终末动脉所在的解剖区域避免使用。尽管文献中缺乏科学证据，但这种并发症在医学法律上被认定为无法抗辩。用于减轻患者局部麻醉剂浸润不适的技术涉及以患者为导向的技术（15例）、注射相关技术（25例）、LA药物相关技术（19例）。详细介绍了这些特定技术的细节。
LA的使用因具体手术情况、患者风险因素以及外科医生个人而异。选择特定LA药物的主要原因是便利性而非药代动力学。注射相关技术是减轻LA疼痛最常用的方法。
