33067 The use of lidocaine jelly for pain control during Mohs surgery as a future practice

Abstract

Lidocaine hydrochloride injection with epinephrine is commonly used for local anesthesia during Mohs surgery. Recently, the U.S. Food and Drug Administration declared a shortage of lidocaine/epinephrine, prompting Mohs surgeons to consider using additional forms of local anesthesia. Lidocaine jelly is a potential substitute for lidocaine/epinephrine and has been shown to prolong the effects of anesthesia during Mohs surgery. In this randomized controlled trial, we assessed the effects of lidocaine jelly in Mohs surgery on 1) the quantity of lidocaine/epinephrine injectable required to maintain anesthesia and 2) pain/anxiety associated with anesthesia injections. Patients were assigned to 2 groups. The treatment group consisted of 124 patients who had lidocaine jelly placed in the wound bed following each Mohs stage. The other 120 had Surgilube placed in the wound following each Mohs stage. Patient vitals were taken and a baseline pain and anxiety survey was administered to all patients prior to the initial analgesia event and subsequently prior to each additional Mohs stage. In absolute terms, both the lidocaine jelly and placebo groups had low levels of pain and anxiety. Additionally, there was no difference in amount of total lidocaine used in both the Surgilube and the lidocaine group. Although adverse toxic effects such as arrhythmias and tissue ischemia are uncommon in Mohs procedures, there may still be benefits to reducing use of anesthetics, especially in light of the recent lidocaine/epinephrine shortage. Future studies should continue to examine the efficacy of other noninvasive methods of pain reduction during Mohs.