Assessing the outcomes, risks, and costs of local versus general anesthesia: A review with implications for cutaneous surgery.

Background: There is a paucity of data providing direct comparison of outcomes, complications, and costs between general and local anesthesia in cutaneous surgery.
Objective: Analyze the literature from dermatologic and other specialties to compare outcomes, risks, and costs of general and local anesthesia.
Methods: A retrospective analysis of case comparison studies from other specialties comparing outcomes, risks, and/or costs in local versus general anesthesia was performed. A review of the literature from dermatology and other specialties was included.
Results: A total of 51 studies were selected; 41 of them directly examined outcomes in procedures performed under local and general anesthesia, and none found a significant difference in outcomes. A total of 41 studies measured adverse effects. Of these, 15 studies (36.6%) report significantly better outcomes between the 2 techniques. Only 2 studies (4.9%) report significantly improved outcomes with use of general anesthesia; 15 of 36 studies (41.7%) report fewer adverse events in local anesthesia. Of the 13 studies that examined costs, all (100%) found significantly decreased costs with use of local anesthesia.
Limitations: These data cannot be seamlessly applied to all cases of cutaneous surgery.
Conclusion: Local anesthesia techniques provide outcomes equal to or better than general anesthesia and with significantly lower costs.
(Copyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)