Injectable Diphenhydramine Used as Anaesthetic for Wide Local Excision With Flap Closure

Abstract

Background: Lidocaine-allergic patients pose a challenge for cutaneous surgical procedures. We present a case of a successful wide local excision with flap closures on the face using topical tetracaine followed by infiltration with 1% diphenhydramine. Case Summary: An 84-year-old woman, with a lidocaine intolerance, presented to the Mohs surgery clinic for wide local excision of a nodular basal cell carcinoma on her right medial cheek. Successful anaesthesia was achieved using topical 4% tetracaine followed by intradermal and subcutaneous injection of 1% diphenhydramine. Haemostasis was achieved with both electrocautery and suture ligation. Sliding rotation flaps were closed using both deep and superficial sutures. Other than some mild discomfort and temporary hyperemia on injection, the patient tolerated the procedure well with no long-term complications. Conclusion: Diphenhydramine is a very useful alternative in lidocaine-intolerant patients for cutaneous procedures including punch and shave biopsies, cyst removals, small elliptical excisions, and wide local excisions.