Use of Local Anesthesia in Office-Based Dermatologic Surgery

Publication Date: June 1, 2016
Last Updated: March 14, 2022


Noncocaine formulations are preferred over cocaine formulations and recommended for use in office-based procedures. (A)

Topical agents are recommended as a first-line method of anesthesia for nonablative laser treatments. (C)

Topical anesthesia can be used for performing office-based procedures, such as skin biopsy, small excisions, and filler and botulinum toxin injections. (C)

The use of topical anesthetic agents is recommended to lessen the pain of injection and reduce the dose of infiltration anesthesia needed for larger procedures. (C)

Topical lidocaine is safe for use on pregnant or nursing women, but there is insufficient evidence to recommend use of other topical anesthetics. (C)
  • Elective procedures and those not of urgent medical necessity requiring topical lidocaine in pregnant women should be postponed until after delivery.
  • Procedures of urgent medical necessity should be delayed until at least the second trimester when possible.

Topical agents are recommended as a first-line method of anesthesia for the repair of dermal lacerations in children and for other minor dermatologic procedures, including curettage. For skin biopsy, excision, or other cases where topical agents alone are insufficient, adjunctive use of topical anesthesia to lessen the discomfort of infiltrative anesthetic should be considered. (A)

For more extensive surgery, the combination of topical and infiltration anesthesia should be considered as an alternate to sedation or general anesthesia in pediatric patients. (C)

Recommendation Grading




Use of Local Anesthesia in Office-Based Dermatologic Surgery

Authoring Organization

Publication Month/Year

June 1, 2016

Last Updated Month/Year

August 1, 2023

Document Type


External Publication Status


Country of Publication


Document Objectives

This guideline addresses the clinical use and safety of local anesthetics (ie, topical, infiltrative, nerve blocks, and infiltrative tumescent) commonly used in office-based dermatologic surgery for adult and pediatric patients. 

Target Patient Population

Patients who needs office-based dermatologic surgery

Inclusion Criteria

Female, Male, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant



Diseases/Conditions (MeSH)

D000758 - Anesthesia, D000772 - Anesthesia, Local, D003880 - Dermatology, D003879 - Dermatologic Agents, D062109 - Dermatologic Surgical Procedures


anesthesia, anesthesia and analgesia