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Anesthesia
Anesthesia
Local anesthesia is not sufficient to perform a true wide excision; therefore general anesthesia is required. The additional use of tumescent anesthesia during general anesthesia could yield advantages. The tumescent anesthetic solution, often consisting of highly diluted lidocaine, epinephrine, and sodium bicarbonate, may reduce intraoperative bleeding and postoperative pain.43,44 A disadvantage of additional tumescent anesthesia is a theoretically higher chance of a postoperative bleeding once the epinephrine has been cleared. When used with general anesthesia, the concentration of lidocaine may be as low as 0.04% to 0.05%; epinephrine is used in a concentration
of 1:1โ2 million; and bicarbonate is added as 10 to 20 mL in 1,000 mL 0.9% NaCl.43
Due to the expected larger systemic uptake of lidocaine as a result of the extensive inflammation in the affected area, the maximum total lidocaine dosage for adults is 500 mg. The solution is subdermally injected using a rotation pump, special tubing, and long needles, and allowed to infiltrate the entire area before initiating the procedure.43