Local Anesthesia
Local anesthesia is required for patient-comfortable skin surgeries.
Because skin surgeries are minor procedures, 1% lidocaine with or without epinephrine is appropriate. Remember not to use epinephrine in skin areas with end arterioles such as ears, nose, fingers, and toes.
The pain and sting of local anesthesia can be minimized by:
Using small needles (i.e., 30-gauge)
Injecting the solution slowly
Warming the solution
Buffering with 8.4% sodium bicarbonate
After cleansing the skin, the usual technique for smaller skin lesions is to raise a skin wheal under the lesion (see picture below). For larger lesions, a four-point field block is effective.
