Efficacy of Local Anesthesia in the Face and Scalp

A Prospective Trial

Tyler Safran, MD; Dino Zammit, MD; Jonathan Kanevsky, MD, FRCSC; Manish Khanna, MD, FRCPC


Plast Reconstr Surg Glob Open. 2019;7(5):e2243 

In This Article


Comparison Trial

To assess the effectiveness of local anesthesia in the face and scalp region, consecutive patients undergoing head and neck cutaneous cancer resection over the period of 3 months (October 2017–December 2017) were enrolled into a prospective trial. The administration of local anesthesia and all surgeries were performed by a single surgeon. All patients were made aware of the trial and received the standard of care for local anesthesia administration. Data collected included type of lesion, age of patient, location of lesion, amount of local anesthesia injected, and time to adequate anesthesia. Given the inherent interest in the location of each lesion, 3 groups were created. Patients were divided into the ear category, lower face, and upper face. The temple region lateral to the lateral canthus was considered lower face, given the distribution of cutaneous nerves to that area are derived from the midface.[4] Upper face was limited posteriorly by the occipital scalp.


Lidocaine 1% with epinephrine (1:100,000) was used for all procedures. The lidocaine was buffered with sodium bicarbonate (8.4% solution) by combining 20 cc of lidocaine with 2 cc of the sodium bicarbonate solution. Lesions were first prepared and marked, followed by a single injection in the subdermal/subcutaneous plane, using a Q-tip distractor, until the infiltrative anesthesia was visible for 5 mm surrounding the lesion. The 5 mm of infiltrative anesthesia was common for all lesions in the study, and all infiltrations were performed with one introduction of the needle under the lesion. Time began once the injection was started for all lesions.


Timing would begin on injection and would end with sufficient anesthesia of the lesion. To test sufficiency, after injection, the surgeon would test pin-prick sensation at 5 points around the lesions: centrally and at each quadrant just outside the markings of the lesion. If any patient required additional local anesthesia throughout the excision, the patient was excluded from the prospective study, given the inability to compare data.

Data Collection and Synthesis

Analysis of data was performed using SPSS v.22 (IBM Corp., Armonk, N.Y.). Outcomes were compared using a t test. All calculated P values were 2-tailed and considered significant for values of P <0.05.