Postoperative Hemorrhage After Lidocaine–Epinephrine Field Block in Cutaneous Surgery: A Letter to the Editor

INTRODUCTION: Epinephrine is used in field block anesthesia for cutaneous surgery to enhance the effect of lidocaine and reduce its systemic effects. It has been hypothesized that the use of epinephrine increases the risk for postoperative hemorrhage in cutaneous surgery. CASE: An elderly male was seen in the clinic for excision of a basal cell carcinoma (BCC) in the right upper trapezius area. A field block was performed by injecting lidocaine 1% with epinephrine 1:200,000 (3 mL) circumferentially around the margins of the excision. Adequate hemostasis was achieved during the procedure and the wound was closed without complication. Approximately 45 min post-excision, the patient returned with profuse active bleeding from the wound. The sutures were removed, and an active arterial bleed was identified. The artery was tied off on the lateral side of the wound to achieve hemostasis. CONCLUSION: A wearing-off effect of epinephrine may increase the risk for postoperative hemorrhage in cutaneous surgery, wherein an intraoperative arterial nick, masked by localized vasoconstriction, is revealed by a relative postoperative vasodilation. Practitioners should be aware of this potential complication.