Anxiolysis, Anesthesia, and Analgesia

The overwhelming majority of skin cancer surgery is accomplished with local anesthesia, which accounts for some of the safety and cost-effectiveness benefits of clinic-based dermatologic surgery vs. procedures conducted in hospital operating rooms. Pain control is one of the most important components of skin cancer surgery. When done well, it makes the surgical experience much more pleasant for both the patient and the surgeon. Pain control for outpatient procedures requires a holistic approach focusing on more than simply the injection of an anesthetic. These considerations include addressing patient pre- and intraoperative anxiety, knowledge of local anesthetics and their additives, skill with appropriate injection techniques to reduce patient discomfort, and the ability to anticipate and address analgesia following the procedure and will be covered in this chapter.