Assessment of intraoperative pain during Mohs micrographic surgery (MMS): An opportunity for improved patient care

Abstract

Background Intraoperative pain during Mohs micrographic surgery (MMS) has not been characterized. However, many patients report postoperative pain on the day of MMS. Objective We sought to determine if patients experience pain during their MMS visit. Methods In phase I of this study, patients were asked to report intraoperative pain level using the verbal numerical rating scale (0–10) at discharge. In phase II, pain levels were assessed before each Mohs layer and at discharge, to determine whether pain was experienced throughout the day. Results Pain was reported at some point during the MMS day for 32.8% of patients (n = 98). The mean pain number reported was 3.7 (range 1–8) out of 10. Pain was more commonly reported by patients who spent a longer time in the office, had 3 or more Mohs layers, and had a flap or graft repair. Patients most frequently reported pain with surgical sites of the periorbital area and nose. Limitations Time between Mohs layers was not measured. There was nonstandardized use of intraoperative local anesthesia volume and oral pain medications. Conclusion Some patients experience pain during MMS. However, the majority of patients report a low level of pain. Additional preventative measures could be considered in patients at higher risk.

Differential Analgesia From Vibratory Stimulation During Local Injection of Anesthetic: A Randomized Clinical Trial

“…17,48 Among MMS patients, there are no reported differences in pain as a function of sex, although male subjects were more likely to require post-MMS opioid analgesia. [3][4][5]49 Although both male and female subjects achieved MCID in our study, only male subjects had the additional statistically significant reduction in NRS due to VAD (see Supplemental Digital Content 1, Table S1, http://links.lww.com/DSS/A211). As with age, different male and female subgroups achieved SCID and statistical significance.…”

“…32,33 Intraoperative and post-MMS pain were more commonly reported on HN treated sites. 3,4,50 Fix andcolleagues 17 found no difference when VAD was applied to any anatomic site; however, only the back, nasofacial sulcus, and forehead were assessed. Our analyses showed MCID and statistically significant reduction in NRS for HN sites, whereas TE sites revealed neither clinical nor statistical differences (see Supplemental Digital Content 1, Table S1, http://links.lww.com/DSS/A211).…”

“…17,24,44 In the intraoperative MMS setting, younger patients are more likely to report pain. 3 However, postoperatively, there are conflicting findings; Limthongkul and colleagues showed no correlation between age and pain, whereas Firoz and colleagues reported increased pain in younger patients. 4,5 In our study, age was found to influence vibration efficacy.…”

“…2 One-third of MMS patients experience significant pain intraoperatively, and over 50% experience pain postoperatively. [3][4][5] Local anesthetics control pain in the dermatologic setting. 6 However, the injection and infiltration of anesthetics causes significant patient discomfort.…”

Pain and anxiety management practices in Mohs micrographic surgery: A UK national survey

“…Intraoperatively, pain has been reported to occur more commonly in patients who spent a longer time in surgery and had three or more Mohs layers. [ 1 ] Anxiety can worsen pain, prolong recovery, and increase the risk of complications. [ 2 ] Together, these factors may negatively affect patient perception of care and overall satisfaction of Mohs micrographic surgery (MMS).…”