H. Smith, P. Chen, C. Vinciullo
In Mohs micrographic surgery, the standard local anaesthetic agent employed is 1% lignocaine with 1:100000 adrenalin. This is injected into the area immediately before surgery, and again after completion of the ﬁrst stage to prevent pain.
Aim To determine if 0.5% bupivacaine with 1:200000 adrenalin used as an adjunctive treatment at the end of stage 1 of Mohs surgery on the nose provides for greater efﬁcacy of anesthetic effect when compared to the use of 1% lignocaine with 1:100000 adrenalin.
All consenting patients undergoing Mohs surgery of the nose received 2.5mls of 1% lignocaine with 1:100000 adrenalin 5 min prior to stage 1. At the end of stage 1, patients were randomised sequentially to either receive 2.5 mL of 0.5% bupivacaine with 1:200000 adrenalin (Gourp A) or 2.5ml of 1% lignocaine with 1:100000 adrenalin (Group B). Patients were tested for pain sensation in the wound using ﬁve pricks with a 21 gauge need prior to further stage or repair. Pain sensation to one or more pricks is recorded as a positive score.
46 consented patients were randomised, with a median age of 64 (range 41 – 87). 40 out 46 lesions (86%) had a histological diagnosis of basal cell carcinoma. No signiﬁcant baseline differences between the two groups. Five out of 23 in Group B were tested positive, with 0 out 23 patients tested positive in Group A (p-value 0.02). Our results suggest that Marcaine is a useful adjunct in Mohs micrographic surgery.