Injection of bupivacaine following Mohs micrographic surgery (MMS): few data exist. Researchers sought to analyze the effects of bupivacaine on postoperative pain and morphine use. Patients who underwent MMS with flap reconstructions designated by the American Academy of Dermatology expert consensus as high-risk for pain and narcotic use were randomly assigned to receive either bupivacaine or saline (placebo) immediately after MMS. Patients recorded their surgical pain levels (0-10 scale) and analgesic use for 48 hours.

Total enrollment was 174, and the odds of using a narcotic analgesic were greater in the placebo group during the whole 48-hour study period (odds ratio 2.58; CI 1.28-5.24; P<.01), not just in the first 24 hours (odds ratio 2.18; CI 1.08-4.41; P=.03) or the second 24 hours (odds ratio 2.18; CI 0.91-5.29; P=.08). At 8 hours, the bupivacaine group had significantly lower pain ratings than the placebo group (mean difference 1.6; CI: 0.73-2.38; P<.001). Patients in both groups used about the same amount of analgesics (both narcotic and non-narcotic) and reported equal rates of pain relief. Neither demographics nor surgical factors differed significantly. There were no untoward incidents.

Following minimally invasive surgery, patients undergoing reconstructions anticipated to cause severe pain benefited from a single dose of bupivacaine, which reduced postoperative pain and the need for narcotic analgesics. Managing postoperative pain and decreasing reliance on narcotics may be possible with the use of bupivacaine in this group.