Vanderbilt University School of Medicine, 200 21 st Ave S, Nashville, TN, 37203, USA.
Carolina Dermatology of Greenville, Greenville, SC, USA.
Arch Dermatol Res. 2021 Oct;313(8):679-684. doi: 10.1007/s00403-020-02155-1. Epub 2020 Oct 30.
General guidelines for the maximum amounts of locally injected lidocaine exist; however, there is a paucity of data in the Mohs micrographic surgery (MMS) literature. This study aimed to determine the safety and adverse effects seen in patients that receive larger amounts of locally injected lidocaine. A retrospective chart review of 563 patients from 1992 to 2016 who received over 30 mL of locally injected lidocaine was conducted. Patient records were reviewed within seven postoperative days for complications. The average amount of anesthesia received was 40 mL, and the average patient weight was 86.69 kg. 1.4% of patients had a complication on the day of surgery, and 4.4% of patients had a complication within 7 days of the surgery. The most common complications were excessive bleeding/hematoma formation and wound infection. Only two complications could be attributable to local anesthetics. Gender, heart disease, hypertension, diabetes, and smoking were not significant risk factors for the development of complications. MMS is a safe outpatient procedure for patients that require over 30 mL of locally injected anesthesia. The safety of high volumes of lidocaine extends to patients with risk factors such as heart disease, hypertension, diabetes, and smoking.
局部注射利多卡因的最大用量存在一般指南；然而，Mohs 显微外科手术（MMS）文献中数据匮乏。本研究旨在确定接受大剂量局部注射利多卡因的患者的安全性和不良反应。对 1992 年至 2016 年间接受超过 30ml 局部注射利多卡因的 563 例患者进行了回顾性图表审查。术后 7 天内对患者的并发症进行了回顾。平均接受的麻醉量为 40ml，平均患者体重为 86.69kg。1.4%的患者在手术当天出现并发症，4.4%的患者在手术后 7 天内出现并发症。最常见的并发症是过度出血/血肿形成和伤口感染。只有两种并发症可以归因于局部麻醉剂。性别、心脏病、高血压、糖尿病和吸烟不是并发症发生的显著危险因素。对于需要超过 30ml 局部麻醉的患者，MMS 是一种安全的门诊手术。利多卡因高容量的安全性也适用于心脏病、高血压、糖尿病和吸烟等危险因素的患者。
