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• W4320883122 abstract "To the Editor: Recent shortages of lidocaine have necessitated identifying alternatives.1Administration USFaD. FDA drug shortages.https://www.accessdata.fda.gov/scripts/drugshortages/Date: 2012Date accessed: October 5, 2020Google Scholar This randomized, double blinded, prospective study assessed the effects of lidocaine jelly (LJ) in Mohs surgery on (1) the quantity of injected lidocaine required to maintain analgesia, and (2) pain/anxiety associated with lidocaine injections. A total of 250 patients with nasal tumors were randomized to application of LJ or water-soluble lubricant (Surgilube, HR Pharmaceuticals) to the wound after each Mohs stage. Gel covered the wound bed but did not exceed 5 grams per application. Wounds were occluded after each stage for a minimum of 30 minutes during tissue processing. All patients received lidocaine with epinephrine injections prior to incision per standard surgical practice after assessing the need for additional numbing with each stage. Wounds were reprepped in a standard sterile fashion before each Mohs stage. The nose was chosen due to the frequency of nasal Mohs cases and the pain associated with nasal injections.2Sniezek P.J. Brodland D.G. Zitelli J.A. A randomized controlled trial comparing acetaminophen, acetaminophen and ibuprofen, and acetaminophen and codeine for postoperative pain relief after Mohs surgery and cutaneous reconstruction.Dermatol Surg. 2011; 37: 1007-1013Crossref PubMed Scopus (70) Google Scholar Baseline pain and anxiety levels were surveyed before the first lidocaine injection and prior to each subsequent Mohs stage. Blood pressure and heart rate were recorded with each survey administration. Due to product availability, injected lidocaine source varied during the study. Descriptive statistics were calculated for patient characteristics, lidocaine (mg), pain, and anxiety scores. Associations with treatment group were tested using equal variance 2 sample t tests for continuous variables, or Fisher’s exact tests for categorical variables. Mean changes from baseline in pain and anxiety were compared between groups using mixed modeling. Models were estimated based on patient vitals and surveys at baseline, and rounds 1, 2, and 3 of treatment due to few patients receiving 4+ rounds of treatment. All hypothesis testing was two-sided (P < .05). Analyses were conducted using SAS software, version 9.4 (SAS Institute Inc). Table I summarizes participant demographics.Table IDemographics, clinical characteristics, and total injected lidocaine used by treatment groupTreatmentWater soluble lubricant (n = 115)Lidocaine jelly (n = 118)Total (n = 233)P-valueGender Male62 (53.9%)74 (52.7%)136 (58.4%) Female53 (46.1%)44 (37.3%)97 (41.6%)Age, y Mean71.772.272.0Race White109 (99.1%)113 (97.4%)222 (98.2%) Hispanic0 (0.0%)2 (1.7%)2 (0.9%) Asian/Pacific Islander1 (0.9%)0 (0.0%)1 (0.4%) Missing527Previous Mohs No53 (48.6%)50 (50.8%)113 (49.8%) Yes56 (51.4%)58 (49.2%)114 (50.2%) Missing606Lidocaine (mg) Mean24.4 (18.80)28.1 (29.00)26.3 (24.52).26 Open table in a new tab There were no statistically significant differences in blood pressure, pulse, pain, or anxiety scores between groups (Table II). There was no statistically significant difference in total injected lidocaine used between groups (Table II). No adverse events or signs of lidocaine toxicity were reported. There was no impact on the quality of the histologic sections in either group.Table IIMean change (95% confidence interval) from baseline in outcomes from vitals and patient surveyWater soluble lubricantLidocaine jellyMean difference between groupsChange from baseline to round 1Average change from baseline across round 1-3Change from baseline to round 1Average change from baseline across round 1-3Change from baseline to round 1P-valueAverage change from baseline across round 1-3P-valueHeart rate−0.1−3.4−3.4−3.3−3.3.060.1.97Systolic blood pressure−2.70.1−1.36.41.4.506.3.33Diastolic blood pressure−3.1−3.9−4.6−4.1−1.5.29−0.2.90Pain0.3−0.30.5−0.20.2.430.2.58I feel comfortable−0.00.00.00.10.0.330.0.70I feel anxious−0.0−0.30.0−0.30.0.330.0.93I feel worried−0.1−0.20.0−0.20.0.270.0.79Estimates and P values from mixed model. Open table in a new tab Estimates and P values from mixed model. Subgroup analysis demonstrated that patients who previously had Mohs surgery received more injected lidocaine than Mohs-naïve patients (31.0 mg vs 20.4 mg; P = .001). While there were no statistically significant differences in initial pain scores between Mohs-naïve and experienced patients, Mohs-naïve patients experienced a greater decrease in pain from baseline to subsequent stages than experienced patients (0.3 vs 0.01; P = .04). Topical lidocaine has been shown to be safe and effective in open wounds.3Janowska A. Papa G. Romanelli M. et al.5% lidocaine hydrochloride cream for wound pain relief: a multicentre observational study.J Invest Surg. 2022; 35: 49-52https://doi.org/10.1080/08941939.2020.1821134Crossref PubMed Scopus (1) Google Scholar LJ has been shown to prolong the effects of lidocaine injections during Mohs.4Robins P. Ashinoff R. Prolongation of anesthesia in Mohs micrographic surgery with 2% lidocaine jelly.J Dermatol Surg Oncol. 1991; 17: 649-652Crossref PubMed Scopus (3) Google Scholar However, previous studies did not limit location to the nose. This may have impacted efficacy in our study. In addition, LJ has been hypothesized to decrease needle stick pain during Mohs.5McLenon J. Rogers M.A.M. The fear of needles: a systematic review and meta-analysis.J Adv Nurs. 2019; 75: 30-42Crossref PubMed Scopus (188) Google Scholar In absolute terms, both groups had low pain and anxiety scores. This may be due to a strong placebo effect in the water-soluble lubricant group. Although there was no difference in amount of total lidocaine used between groups, LJ may still benefit some patients, including those who have not had Mohs previously. As shortages of local anesthetics continue, it will be necessary to find alternatives. Future studies should continue to examine the efficacy of other noninvasive methods of pain reduction during Mohs. None disclosed." @default.
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• W4320883122 date "2023-06-01" @default.
• W4320883122 modified "2023-09-30" @default.
• W4320883122 title "A randomized, double-blind, prospective study to assess lidocaine jelly for pain control during Mohs surgery" @default.
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• W4320883122 doi "https://doi.org/10.1016/j.jdin.2023.01.020" @default.
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