@article{fc8277ca03b640eea82c20b35c378cbd,
title = "Guidelines for the use of local anesthesia in office-based dermatologic surgery",
abstract = "There are an increasing number and variety of dermatologic surgical procedures performed safely in the office setting. This evidence-based guideline addresses important clinical questions that arise regarding the use and safety of local anesthesia for dermatologic office-based procedures. In addition to recommendations for dermatologists, this guideline also takes into account patient preferences while optimizing their safety and quality of care. The clinical recommendations presented here are based on the best evidence available as well as expert opinion.",
keywords = "anesthesia, clinical guideline, dermatology, education, epinephrine, infiltration, local anesthesia, local nerve block, office-based surgery, pain, safety, topical, tumescent",
author = "Kouba, {David J.} and Lopiccolo, {Matteo C.} and Murad Alam and Bordeaux, {Jeremy S.} and Bernard Cohen and Hanke, {C. William} and Nathaniel Jellinek and Maibach, {Howard I.} and Tanner, {Jonathan W.} and Neelam Vashi and Gross, {Kenneth G.} and Trudy Adamson and Begolka, {Wendy Smith} and Moyano, {Jose V.}",
note = "Funding Information: The most current and highest level of evidence was examined in order to create this guideline. This thorough appraisal of the literature has revealed several areas in which additional investigation is needed regarding the use of local anesthesia for dermatologic procedures. Although mention is made in the narrative above, the work group would like to place additional emphasis on gaps in research, which include but are not limited to: randomized controlled trials to compare topical anesthetic to infiltrative local anesthetic for minor dermatologic procedures in children and adults; studies examining the effect of occlusion and type of vehicle (ie, cream, gel, and ointment) on the safety and efficacy of topical anesthetics; randomized controlled trials to compare the pain of administration and anesthetic efficacy of infiltrative anesthesia versus regional nerve block for dermatologic surgery on the face, hands, feet, and digits; additional data on the maximum safe dosage of local infiltration anesthesia for large, multistage procedures, such as Mohs micrographic surgery; additional trials on effectiveness of techniques used to decrease the pain of administering infiltrative anesthesia, including methods of auditory and visual distraction in children; well-designed studies to determine the utility of combining different infiltrative anesthetics for the same procedure; randomized controlled trials to examine the benefits of adding hyaluronidase to local infiltrative anesthesia; and randomized controlled trials to examine the effect rate of infiltration has on patient discomfort during tumescent local anesthesia for liposuction. It is hoped that such gaps are closed to further optimize the use of local anesthesia for office-based dermatologic surgery. The American Academy of Dermatology (AAD) strives to produce clinical guidelines that reflect the best available evidence supplemented with the judgment of expert clinicians. Significant efforts are taken to minimize the potential for conflicts of interest to influence guideline content. The management of conflict of interest for this guideline complies with the Council of Medical Specialty Societies' Code of Interactions with Companies. Funding of guideline production by medical or pharmaceutical entities is prohibited, full disclosure is obtained and evaluated for all guideline contributors throughout the guideline development process, and recusal is used to manage identified relationships. The AAD conflict of interest policy summary may be viewed at www.aad.org . The below information represents the authors disclosed relationships with industry. Relevant relationships requiring recusal for drafting of guideline recommendations and content were not noted for this guideline. Murad Alam, MD, served as consultant for Amway Corporation, receiving honoraria, and as Principal Investigator (PI) for OptMed, receiving grants with no personal compensation received. Bernard Cohen, MD, served on the Advisory Board of Sanofi-Aventis, receiving honoraria. C. William Hanke, MD, received honoraria serving on the Advisory Board of Allergan, Inc, as consultant for Orlando Dermatology Aesthetic & Clinical, as speaker for LEO Pharma and Genentech, Inc, and in other roles for Educational Testing and Assessment Systems, Inc and for Sanova Works. In addition, Dr Hanke served as PI in grants funded by Allergan, Inc, Derm Advance, Genentech, Inc, and LEO Pharma, and received compensation for patent royalties or other compensation for intellectual property rights from Elsevier, Informa HealthCare, and Springer Science & Business Media. Neelam Vashi, MD, served as a consultant to L'Oreal, receiving honoraria. Trudy Adamson, Jeremy Burdeaux, MD, MPH, Nathaniel Jellinek, MD, David Kouba, MD, PhD, Matteo LoPiccolo, MD, Howard Maibach, MD, Jose Moyano, PhD, and Wendy Smith Begolka, MBS have no relevant conflicts of interest to disclose. Publisher Copyright: {\textcopyright} 2016 American Academy of Dermatology, Inc.",
year = "2016",
month = jun,
day = "1",
doi = "10.1016/j.jaad.2016.01.022",
language = "English (US)",
volume = "74",
pages = "1201--1219",
journal = "Journal of the American Academy of Dermatology",
issn = "0190-9622",
publisher = "Mosby Inc.",
number = "6",
}