Tumescent local anesthesia in geriatric patients with head and neck skin cancer – a retrospective study of 782 patients

• Published in: Journal der Deutschen Dermatologischen Gesellschaft Vol. 22; no. 2; pp. 210 - 221
• Main Authors: Schnabl, Saskia Maria, Garbe, Claus, Breuninger, Helmut, Walter, Vincent, Aebischer, Valentin, Huynh, Julia, Ghoreschi, Franziska Carola, Häfner, Hans‐Martin, Scheu, Alexander
• Format: Journal Article
• Language: English
• Published: Germany Wiley Subscription Services, Inc 01.02.2024
• Subjects: Analgesia; Analgesics; Anesthesia; Cancer surgery; Complications; Dehiscence; Drug interaction; elderly patients; Head & neck cancer; Hemoglobin; Local anesthesia; local postoperative complications; multimorbidity; Nonsteroidal anti-inflammatory drugs; Pain perception; Patients; Postoperative; postoperative pain management; Skin cancer; Surgery; tumescent local anesthesia; multimorbidity; elderly patients; tumescent local anesthesia; local postoperative complications; postoperative pain management
• ISSN: 1610-0379; 1610-0387; 1610-0387
• DOI: 10.1111/ddg.15287

Summary Background and Objectives Due to frailty, dermatosurgery in the elderly is preferably performed under tumescent local anesthesia, but data is limited. The aim was to evaluate tumescent local anesthesia for skin cancer surgery in the elderly with focus on clinical benefits (treatment processes, pain management) and local postoperative complication risk. Patients and Methods Investigation of patients ≥ 75 years with inpatient head and neck skin cancer surgery under tumescent local anesthesia. Results 2,940 procedures in 782 patients (mean age 83.3 years) were performed with the aim of complete tumor resection during the inpatient stay. 3.8 (range: 1–20) interventions were done over an average of 4.9 days (range: 1–28). 43.2% did not require any postoperative analgesia. 53.5% received NSAIDs, 3.3% opioids. Infection (13.6%) was the most common local postoperative complication. Surgical intervention due to bleeding was required in 2.8%. None was hemoglobin relevant or life‐threatening. Suture dehiscence and necrosis were rare (0.6%). Conclusions Tumescent local anesthesia is an effective method for skin cancer surgery in the elderly. By avoiding general anesthesia, treatment processes can be optimized and anesthesiologic risks minimized. Local postoperative complications are still low and well treatable. The long‐lasting analgesia results in a reduced need for analgesics and drug interactions.