PracticeUpdate Dermatology Best of 2018

EDITOR’S PICKS 18

Local Anesthesia in Pediatric Dermatologic Surgery Pediatric Dermatology Take-home message • The authors of this questionnaire study evaluated the psychological distress and global satisfaction of 388 children who were involved in a patient-centered approach to dermatologic surgery under local anesthesia involving oral and written therapeutic measures. The mean age of children in this study was 11.0 years. In total, 97.5% of children reported satisfaction with their surgical team, and 45.5% reported that they were not afraid of the procedure (47.7% reported little fear and 6.8% reported much fear). Fear of pain associated with the injection was the most common worry among the children, and this improved with reassurance and explanation by the surgical team. Drawing was a particularly effective distraction technique for the children. Of the parents surveyed, 95.4% were satisfied with the relationship between the dermatologist and their child, and no parent surveyed stated that he or she would have preferred to have the procedure performed under general anesthesia or deep sedation. Finally, 10% of parents reported that their child had behavior problems, specifically transient sleep disturbances, during the first postoperative week. • The data of this study suggest that the dermatologic procedures performed under local anesthesia are not overly traumatic for the majority of children and parents, and specific education measures for pediatric patients, including drawing, may be beneficial for reducing fear of the procedure. Jeffrey F. Scott MD

COMMENT By Brandi M. Kenner-Bell MD T his study was designed to assess the psychological effects and overall patient and family satis- faction of a systematic patient-centered approach to pediatric dermatologic sur- gery performed under local anesthesia. The approach involved the following: 1) an honest age-appropriate explanation of the procedure at the initial visit; 2) a cartoon brochure to be taken home and reviewed with the patient by the parents; 3) a recheck of the patient and parent’s understanding of the procedure on the day of surgery; 4) application of a topi- cal anesthetic; 5) one parent allowed to accompany the child into the operating room; 6) the patient offered a variety of distraction techniques during the pro- cedure (drawing, electronic games, or conversation); and 7) each patient given a reward certificate at the conclusion of the procedure. The authors provided a self-administered questionnaire to the patient immedi- ately after the procedure and another to the parent at discharge. The authors found that the vast majority of patients and their parents had a positive expe- rience, with 80% of parents reporting that their child did not have a traumatic experience and no families indicating that they would have preferred to have the procedure performed under gen- eral anesthesia. The authors concluded that a patient-centered approach was a patient- and parent-satisfying, mini- mally traumatic, and cost-effective way to perform minor dermatologic proce- dures in children. Interventions that the authors found particularly helpful were the cartoon brochures detailing the surgery and the certificate of merit the children received at the conclusion of the procedure, regardless of their atti- tude during the procedure. These seem like very practical additions that many of us could make to our surgical practices, which could ease some of our patients’ anxiety and reward their bravery.

accompanied by oral and written therapeutic education measures (structured information and a cartoon brochure illustrating the procedure) addressed to children and parents. Distraction techniques were also used during the procedures. RESULTS Although 54.5% of patients manifested some degree of fear, all other parameters ana- lyzed (pain, surgery-related distress, surgical team-patient and -family relationship, global sat- isfaction) indicated that the procedures resulted in limited distress and that the large majority of children and parents tolerated them well. CONCLUSION Specific measures for therapeutic pediatric patient education may be helpful in limiting discomfort, anxiety, and pain percep- tion linked to procedures performed under local anesthesia. Further controlled studies are required to more precisely assess the bene- fits of specific therapeutic education measures. Local Anesthesia in Pediatric Dermatologic Surgery: Evaluation of a Patient-Centered Approach. Pediatr Dermatol 2017 Dec 15;[EPub Ahead of Print], M El Hachem, C Carnevale, A Diociaiuti, et al. www.practiceupdate.com/c/62164 " …a patient-centered approach was a patient- and parent- satisfying, minimally traumatic, and cost- effective way to perform minor dermatologic procedures in children. "

Abstract BACKGROUND/OBJECTIVES A few studies have documented the effect of local anesthesia for minor dermatologic surgical procedures on chil- dren and their parents. Our objective was to evaluate the psychological effect and global satisfaction of a patient-centered approach to dermatologic surgery under local anesthesia. METHODS Two self-administered questionnaires were used to evaluate the distress and global satisfaction of 388 children who underwent dermatologic surgery under local anesthesia,

Dr. Kenner-Bell is an Assistant Professor of Pediatrics and Dermatology at Northwestern University Feinberg School of Medicine and Attending

Physician in the Division of Dermatology, Lurie Children’s Hospital of Chicago in Chicago, Illinois.

PRACTICEUPDATE DERMATOLOGY