Photo Credit: Ruslan malysh
The following is a summary of “Liposomal and Nonliposomal Bupivacaine for Mohs Surgery: A Systematic Review,” published in the January 2024 issue of Dermatology by Jeha, et al.
Lidocaine is the most common local anesthetic used for Mohs micrographic surgery (MMS); as it has a short half-life, patients still worry about pain after surgery. Bupivacaine is used in several specialist surgeries and is more effective at relieving pain than lidocaine. However, more is needed to know about its role in MMS.
For a study, researchers sought to carefully read through all the recent research on using bupivacaine for MMS, including both older nonliposomal formulations and younger liposomal formulations.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 standards were used for a systematic review. Articles with new information about using bupivacaine for MMS were searched for in the MEDLINE, PubMed, and EMBASE databases. Of the 483 articles that might have been relevant, only 3 met the final criteria for inclusion. These studies included 253 patients who were part of the main investigations that compared bupivacaine to traditional local anesthesia for MMS. Bupivacaine was well accepted and was linked to similar or slightly lower pain and drug use during and after surgery.
During surgery, bupivacaine may help keep the patient asleep longer, ease pain after surgery, and lower the need for opioids after MMS. However large prospective planned studies are needed to ensure that these results can be used in other situations and are useful in practical settings.
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