Tumescent Local Anesthesia and Surgical Management of Large Malignant Cutaneous Tumors in the Elderly
BLATIERE V | JC Sleth
Seance of wednesday 26 june 2019 (Chirurgie dermatologique)
DOI number : 10.26299/fwe5-fb97/emem.2018.1.019
Abstract
Surgical management of large, malignant skin tumors in the elderly is a reality. The problem is to improve the active life expectancy, that is to say the number of years to live in a non-dependence, with a good quality of life. It is therefore necessary to adapt to the characteristics of geriatrics.
Conventional local anesthesia is often impossible because of maximal doses we can use. General anesthesia can be a challenge between benefits and risks, especially for post-operative cognitive disorders. Whenever possible, alternatives to general anesthesia should be promoted. The tumescent local anesthesia described by J.A Klein for liposuction in 1987, is an infiltration of a large volume of local anesthetic, with very low concentration in an alkaline environment, associated with a vasoconstrictor. It has since been used by many authors in dermatological surgery. There are variations in the choice of local anesthetic for the teams. For our part it is a solution of 500ml of Ringer combined with 20ml of ropivacaine 0.75%, 20ml of lidocaine 2% and 0.5 mg of adrenaline that we have been using for more than 10 years.
Conventional local anesthesia is often impossible because of maximal doses we can use. General anesthesia can be a challenge between benefits and risks, especially for post-operative cognitive disorders. Whenever possible, alternatives to general anesthesia should be promoted. The tumescent local anesthesia described by J.A Klein for liposuction in 1987, is an infiltration of a large volume of local anesthetic, with very low concentration in an alkaline environment, associated with a vasoconstrictor. It has since been used by many authors in dermatological surgery. There are variations in the choice of local anesthetic for the teams. For our part it is a solution of 500ml of Ringer combined with 20ml of ropivacaine 0.75%, 20ml of lidocaine 2% and 0.5 mg of adrenaline that we have been using for more than 10 years.