if the patient is taking any of the medications and appropriate medical actions taken to avoid these interactions should be discussed with the patient’s healthcare team.

wide spread. Tetracaine is also not commonly used in dermatologic surgery. It is used more frequently for spinal anesthesia.

Summary: Method of Injection

•Infiltration of local anesthetic is the most commonly used technique of administering local anesthetic.

•Both subcutaneous and intradermal injections lead to distortion of the skin surface. This can be avoided by preoperative marking and gentle massaging of the skin.

5.9Method of Injection

Infiltration of local anesthetic is the most commonly used technique of administering local anesthetic [4]. The smallest possible needle and syringes should be used in order to minimize pain and injection pressure [4]. Generally, 5–10-mL syringes are useful for local infiltration along with needles that are 25–30 gauge [4]. Subcutaneous injections are associated with a longer time to onset and shorter duration, while dermal injections are more painful but tend to have a shorter time to onset and longer duration of action [4]. Both subcutaneous and intradermal injections lead to distortion of the skin surface. This can be avoided by preoperative marking and gentle massaging of the skin.

Summary: Amino-Esters

•Procaine was the first injectable local anesthetic, and is associated with a significant risk of allergic reactions.

5.10Amino-Esters

Procaine was the first injectable local anesthetic; however, it has not been used as widely since the introduction of lidocaine. Procaine is associated with a significant risk of allergic responses. Chloroprocaine has been primarily used as an epidural anesthetic in obstetrics. Its use in dermatologic surgery has not been

Summary: Amino-Amides

•Lidocaine is the most commonly used local anesthetic in dermatologic surgery. It can be used for topical, regional, or intravenous administration.

•Mepivacaine has a slightly longer duration of action and is associated with less vasodilation than lidocaine.

•Bupivacaine is commonly used for peripheral nerve blocks, but it also is known to disrupt AV nodal conduction and depress myocardial contractility [7].

•Ropivacaine is less cardiotoxic than bupivacaine and may be more beneficial in cases where a large dose of anesthetic is required for a peripheral nerve block.

•Levobupivacaine is associated with less cardiotoxicity than bupivacaine and also may be more beneficial when large doses of anesthetic are required for a peripheral nerve block.

5.11Amino-Amides

Lidocaine is the most commonly used local anesthetic in dermatologic surgery. It can be used for topical, regional, or intravenous situations. Mepivacaine has very similar clinical properties to lidocaine. In comparison to lidocaine, it has a marginally longer duration of action and is associated with less vasodilation [3]. It is not very effective as a topical local anesthetic and is currently not approved for use in the United States. When found in the plasma in high concentrations, its metabolism can lead to the production of ortho-toluidine which converts hemoglobin to methemoglobin leading to methemoglobinemia. Bupivacaine is commonly used for peripheral nerve blocks. It has been associated with refractory cardiac arrest when injected intravascularly at the 0.75% concentration. Bupivacaine is considered to be a “fast-in, slow-out” anesthetic because it tends to slowlydissociatefromthesodiumchannelonceitisattached [3]. It is also known to disrupt AV nodal conduction and