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


Patient Demographics

Between October 1, 2017, and December 1, 2017, 114 patients underwent face and scalp cutaneous cancer excision. Twelve patients (all with lesions in the scalp) were excluded for having required additional anesthesia. In all, 102 patients were included in the prospective study. Among the patients included, 61.8% (n = 63) were men and 38.2% (n = 39) women. The average age of patients included was 74.3 years old (n = 102).

Location of Lesions

Lesions were mainly found in the lower region, the face (60.8%; n = 62), followed by the upper region (29.4%; n = 30), and finally the ear (9.8%; n = 10). Of the lesions included, 72.5% (n = 74) were confirmed by pathology to be basal cell carcinomas (BCC), 26.5% (n = 27) were squamous cell carcinomas (SCC), and 0.01% (n = 1) were lentigo maligna (LM).

Amount of Local Anesthesia Injected

When comparing the amount of local anesthesia injected, there were no significant differences between any of the groups (P > 0.05). The upper face required a mean of 6.06 cc (n = 30), the lower face required 4.74 cc (n = 62; P = 0.08), and the ear required 3.76 cc (n = 10; P = 0.12) of local anesthesia. Additionally, there was no significant difference between amount injected and the type of lesion (comparing SCC, BCC, and LM; P > 0.05).

Size of Lesion

When comparing the average size of lesions between anatomical regions, there was no significant difference between the sites (P > 0.05). Upper face had a mean size of 253.2 mm2 (n = 30), lower face 187.23 mm2 (n = 62; P = 0.2), and ear 199.9 mm2 (n = 10; P = 0.2).

Time to Anesthesia

When comparing time to anesthesia for types of lesions, there was no significant difference between SCC, BCC, and LM (P > 0.05). There was, however, a significant difference between upper face (mean, 153.54 seconds) and both lower face (mean, 69.37 seconds) (P < 0.001) and ears (mean, 60.2 seconds) (P < 0.001). There was, however, no difference when comparing lower face with ear group (P = 0.2). A full breakdown of results can be seen in Table 1, Table 2 and Table 3.