Médecine

Paramédical

Autres domaines


S'abonner

Safety of peak serum lidocaine concentration after Mohs micrographic surgery: A prospective cohort study - 24/04/13

Doi : 10.1016/j.jaad.2009.08.046 
Murad Alam, MD, MSCI a, b, c, , Dominic Ricci, MD e, Jillian Havey, BS a, Alfred Rademaker, PhD d, Joslyn Witherspoon, MD, MPH a, Dennis P. West, PhD a
a Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 
b Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 
c Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 
d Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 
e Loyola University, Stritch School of Medicine, Maywood, Illinois 

Reprint requests: Murad Alam, MD, MSCI, Department of Dermatology, Northwestern University, 676 N St Clair, Suite 1600, Chicago, IL 60611.

Abstract

Background

Large volumes of dilute local anesthesia are increasingly used not only for liposuction but also for other large cutaneous surgeries, including skin cancer excision. Although the lidocaine serum levels and peaks after injection of tumescent anesthesia in the trunk were shown to be safe even when used in high doses, the levels after use of less dilute (1% lidocaine) solutions for facial cancer surgery have not been described.

Objective

We sought to ascertain whether perioperative peak lidocaine levels during Mohs micrographic surgery approach thresholds for lidocaine toxicity.

Methods

In this prospective cohort study, each Mohs micrographic procedure was commenced per routine protocol, with use of injectable 1% lidocaine with 1:200,000 epinephrine and 1:10 8.4% bicarbonate for local anesthesia. Six peripheral blood draws of 5 mL each were performed and sent for serum lidocaine concentration measurement. Blood draws were obtained before and after the first two stages of Mohs micrographic surgery, and before and after the third stage or wound repair, as appropriate. Subjects and investigators reported any symptoms or signs of lidocaine toxicity. The main outcome measures include: (1) number of subjects exhibiting at least one level higher than the threshold for toxicity; and (2) sustained elevated lidocaine levels in one or more subjects.

Results

Mean total lidocaine volume per subject was 15 mL (range: 5-48 mL). The highest peak serum lidocaine level detected at any time point (blood draw) for any subject was 0.3 μg/mL. Mean serum lidocaine level for all 6 time points was less than 0.1 μg/mL and was thus not detected. Detectable lidocaine levels were found to be associated with higher mean (P = .028) and median (P = .008) total lidocaine doses. Because no toxic levels were detected, it was not possible to measure sustained high lidocaine levels.

Limitations

Limitations of this study include the lack of use of very concentrated (eg, 2% vs 1%) lidocaine solution.

Conclusions

Lidocaine use during Mohs micrographic surgery does not appear to result in serum lidocaine levels approaching toxic levels even when relatively high total lidocaine doses are used. There is an association between higher total lidocaine dose and perioperative peak serum lidocaine level.

Le texte complet de cet article est disponible en PDF.

Key words : local anesthesia, Mohs micrographic, safety, surgery, toxicity


Plan


 Conflicts of interest: None declared.
 Supported by Departmental Research Funds, Department of Dermatology, Northwestern University.
 ClinicalTrials.gov Identifier NCT00793169


© 2009  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 63 - N° 1

P. 87-92 - juillet 2010 Retour au numéro
Article précédent Article précédent
  • An analysis of pain and analgesia after Mohs micrographic surgery
  • Bahar F. Firoz, Leonard H. Goldberg, Ofer Arnon, Adam J. Mamelak
| Article suivant Article suivant
  • Spatiotemporal expression pattern of neuroepithelial stem cell marker nestin suggests a role in dermal homeostasis, neovasculogenesis, and tumor stroma development: A study on embryonic and adult human skin
  • Klaus Sellheyer, Dieter Krahl

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.