The authors describe an easy to make and apply rule for local tumescent anesthetic solution in dermatologic surgical procedures. They attest the safety and simplicity of the rule, based on ambulatory surgery practice for over 20 years and 8 years usage of the solution in more than a thousand procedures.

Keywords: TUMESCENT LOCAL ANESTHESIA

Introduction: Needle infi ltration of local anesthetic is a painful procedure, thus, a topical anesthetic is a comfortable alternative; however, it is difficult to deliver transcutaneous polar drugs. Iontophoresis is a noninvasive technique that uses electrical current for releasing electrically charged drugs through biological membranes. Objective: To evaluate the anesthesia induced by iontophoresis of lidocaine for a standardized painful stimulus. Material and methods: Randomized, controlled, double-blind study, involving 10 volunteers under the anesthetic effects of topical application of lidocaine gel 2% and noradrenaline 1:50,000, with or without iontophoresis of 1.85 milliamps for 13 minutes. Pain sensitivity was evaluated by the prick of a 21G needle in the arms posterior region, using a visual numerical scale. Results: Patients mean age was 50.8 ± 11.4 years. Nine of them were women. All had previously received infi ltrative anesthesia. Iontophoresis was well tolerated by volunteers. The median pain scores were 0 and 3 for the arm that received the iontophoresis and for the one that did not receive, respectively (p < 0.01). Conclusion: The anesthetic effect in the region subjected to iontophoresis suggests an effi cient and comfortable method for promoting local anesthesia in the surgical approach of pediatric, hyperalgic, or needlephobic patients.

Keywords: ANESTHESIA, LIDOCAINE, AMBULATORY SURGICAL PROCEDURES, IONTOPHORESIS

Introduction: Local anesthesia is the most common form of anesthesia used in cutaneous surgery. Some patients have comorbidities that put them at risk for general anesthesia.Tumescent anesthesia is the technique of injecting a large amount of dilute local anesthesia into the subcutaneous plane of the skin.Tumescent anesthesia can minimize discomfort, aid in hemostasis, and contribute to the ease of closing large surgical defects that would otherwise be challenging. Objective: To discuss the pros and cons of using tumescent anesthesia in dermatologic surgery. Conclusion: Tumescent anesthesia is a viable option that can aid in cutaneous reconstructive surgery, especially when removing tissue in the deeper subcutaneous fat or fascia.Tumescent anesthesia is also associated with good results and few adverse reactions.

Keywords: ANESTHESIA, SKIN NEOPLASMS, MOHS SURGERY

Introdução: The increase in the demand for cosmetic procedures has in turn stimulated the search for effective and safe analgesia.Topical anesthetics are an alternative to infiltrative anesthesia, and promote an appropriate analgesia without inducing adverse effects. Objective: To compare the pain ratings of two topical lidocaine formulations in patients undergoing fractional CO2 laser therapy. Methods: Eight patients underwent a single fractional CO2 laser session after applying a commercial formulation of 4% lidocaine on the right side of the face and a dispensed 30% lidocaine formulation combined with 7% tetracaine on the left side of the face.The intensity of the pain was assessed using the visual analogue pain intensity scale at the end of the procedure. Results: No significant statistical differences were detected between the formulations. Conclusions: Formulations with high concentrations of anesthetics are not more effective than commercial products in producing analgesia.

Keywords: ANESTHETICS, ANESTHESIA AND ANALGESIA, LASERS

Introduction: Liposuction is a cosmetic procedure that removes undesired body fat. More recently, it has been associated with complications and deaths, raising concerns about the risk involved in the procedure. Since the tumescent technique was described by Jeffrey Klein, surgeons from around the world have contributed to the development of the technique, making liposuction with microcannulas and local anesthesia a safe and effective procedure that achieves its objective. Nevertheless, severe complications and deaths are described in the literature when the procedure is performed under general anesthesia or with IV drugs, or when there is a breach of the protocols recommended for local tumes- cent anesthesia. Therefore, it is necessary to establish protocols for liposuction procedures that use local tumescent anesthesia, to promote safety.
Objective:To demonstrate that using local tumescent anesthesia in liposuction is safe.
Methods: Retrospective study of medical records of 568 patients who underwent 1,107 liposuction procedures assisted by local tumescent anesthesia between 1998 and 2004.
Results: There were no deaths or complications that required hospitalization.
Conclusions: When standardized protocols are observed, liposuction assisted exclusively by local tumescent anesthesia was shown to be a safe procedure.

Keywords: LIPECTOMY, ANESTHESIA, LOCAL, SAFETY

True gynecomastia is a benign proliferation of the glandular tissue of the male breast. In general, management is conservative, however if there is development of fibrosis after the inflammatory phase, surgery is recommended. The present article describes a case of true gynecomastia with symmetrical enlargement of the breasts since adolescence. In light of this diagnosis, corrective surgery was performed with tumescent anesthesia and exeresis in block of the mammary gland.

Keywords: GYNECOMASTIA; AMBULATORY SURGICAL PROCEDURES; DERMATOLOGY; ANESTHESIA, LOCAL.

Deep phenol chemical peeling with the Baker-Gordon formula is indicated for the treatment of severe facial aging. A review of pertinent literature on its main limiting factor-pain-was carried out with searches on two databases (PubMed and Cochrane Library) using the following keywords: chemexfoliation, peel, peeling, and phenol, also cross-referencing with the terms anesthesia and analgesia. The search resulted in 151 articles that contributed little to clarifying what would be the ideal approach for managing pain when using a deep chemical peel with the Baker-Gordon formula. As a result, for this procedure, the authors basically relied on the expert experience-in this case, that of the anesthesiologist-which has been described. Therefore, further studies should be carried out in order to achieve a higher level of scientific evidence.

Keywords: CHEMEXFOLIATION; PHENOL; ANESTHESIA; ANALGESIA.

Introduction: Managing pain during the performance of dermatological procedures is a challenge. Several topical anesthetics are available for use prior to carrying out minimally invasive treatments.
Objective: To evaluate the efficacy of topical anesthetics for reducing the pain during dermatological procedures and to compare the effectiveness of two different anesthetics using the visual numeric pain scale.
Methods: Twenty-five patients underwent facial dermatological procedures after the application of two commercial preparations: one containing 7% lidocaine and 7% tetracaine (applied in one hemiface) and the other containing 4% lidocaine. Each of the preparations was applied in one hemiface. Pain intensity was assessed using the Visual Numeric Pain Scale (VNS) at the end of the procedure.
Results: Eighty-four percent of the patients reported a lower pain score in the hemiface that received the commercial preparation containing 7% lidocaine and 7% tetracaine. The mean pain score in the hemifaces that received the 4% lidocaine preparation was 7.3, while that computed for the hemifaces that received the 7% lidocaine and 7% tetracaine preparation was 5.3.
Conclusions: Topical anesthetics are effective and safe for pain reduction in dermatological procedures, with the commercial preparation containing 7% lidocaine and 7% tetracaine was more effective than the one containing 4% lidocaine.

Keywords: Anesthesia; Anesthesia, local; Dermatologic surgical procedures; Minimally invasive surgical procedures; Pain perception; Pretreatment

O queratoacantoma (QA), apesar de frequente na prática diária, é um tumor que gera questionamentos. O aspecto mais intrigante associa-se à sua posição no limite entre malignidade e benignidade. A abordagem do tumor, bem como sua classificação, é controversa. Na definição da conduta, é importante levar em conta o potencial de transformação para carcinoma espinocelular. Desse modo, a excisão cirúrgica é a terapia de escolha, sempre que possível. Algumas situações merecem atenção adicional, como a imunossupressão associada. Neste artigo, relatamos um caso de QA gigante em um paciente com síndrome da imunodeficiência adquirida tratado com cirurgia micrográfica de Mohs.

Keywords: Ceratoacantoma; Retalhos Cirúrgicos; Neoplasias Nasais; Neoplasias Cutâneas; Cirurgia de Mohs; Síndrome de Imunodeficiência Adquirida; HIV; Imunossupressão

Prominent ears are a common congenital deformity, affecting around 5% of the population, in addition to harming self-esteem and psychological well-being. To report a case of closed otoplasty in a 37-year-old patient who was dissatisfied with the results of an open otoplasty performed in childhood, with recurrence and erasure of the antihelix. The closed, incisionless technique was performed with local anesthesia and Mustardé percutaneous sutures, creating the antihelix with no need for incisions. The procedure was performed in an outpatient setting, with sutures buried under the skin and no apparent stitches, followed by the use of an immobilization bandage at night for 2 months. The surgery was completed in approximately 30 minutes per ear, with no complications. The patient reported mild to moderate pain in the first few days, which was relieved with analgesics. No complications, such as hematomas or keloids, were observed at the 2- and 24-month follow-up visits. The patient was highly satisfied with the aesthetic result and modeling of the antihelix. Closed otoplasty proved to be an effective and safe alternative for correcting prominent ears, with significant aesthetic and psychological benefits. It is suitable for cases of mild to moderate deformity.

Keywords: Surgery, Plastic; Anesthesia; Minor Surgical Procedures.