Nerve blocks: Recommendations

Does nerve block/regional anesthesia represent a clinical benefit over local infiltrative anesthesia for head and neck, hands, feet, and genitals?
Regional cutaneous nerve block anesthesia is recommended for ablative laser resurfacing of the face and botulinum  toxin injection of the palm
Strength of recommendation: B   Level of evidence: II
Does the injection of local anesthesia in the optimal entry points for the head and neck, hands, feet, and genitals pose an increased risk of nerve damage from needle trauma, and of toxicity?Nerve block should be considered as an alternative or in addition to infiltrative anesthesia for procedures on the face, hands, feet, and digits, and may provide the benefit of decreased tissue swelling/distortion, prolong anesthesia, and reduce postoperative discomfort for the patient.

Strength of recommendation: C   Level of evidence: III


A majority of investigations into the utility of nerve block anesthesia have been conducted outside the realm of dermatology, with dental studies dominating.  Research for use in dermatologic procedures has found the technique to be safe when performed in this setting.  Neither nerve damage nor other major adverse events have been reported, and mild events were limited to hematoma formation and one case of pain at the site of ulnar nerve block, all of which were transient.54,115,118-125

Citation note

When referencing this guideline in a publication, please use the following citation: Kouba DJ, LoPiccolo MC, Alam M, Bordeaux JS, Cohen B, Hanke CW, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016 Feb 27. pii:S0190-9622(16)00074-8. 


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