From the Guidelines
For incision and drainage of an axillary abscess under local anesthetic, it is better to use 1% lidocaine with epinephrine, as the benefits of epinephrine, including reduced bleeding and prolonged anesthesia, outweigh the risks in this anatomical location, according to the most recent and highest quality study available 1. When performing the procedure, infiltrate the 1% lidocaine with epinephrine around the periphery of the abscess (not directly into it) using approximately 5-10 mL depending on the size of the abscess. The key benefits of using epinephrine in this context include:
- Reduced bleeding, which can improve visibility and reduce the risk of complications
- Prolonged anesthesia, which can reduce the need for additional injections and improve patient comfort
- Enhanced vasoconstriction, which can help to reduce swelling and promote healing Allow 5-10 minutes for adequate anesthesia before making your incision. The maximum safe dose of 1% lidocaine with epinephrine is 7 mg/kg (or about 50 mL of 1% solution for a 70 kg adult) 1. It is essential to note that the addition of epinephrine to local anesthesia has been shown to be safe in various anatomical locations, including the digits, hands, and feet, without increasing the risk of necrosis 1. However, it is crucial to use the lowest effective concentration of epinephrine to minimize potential side effects, such as palpitations and anxiety 1. In this case, the use of 1% lidocaine with epinephrine is recommended, as it provides effective anesthesia and minimizes the risk of complications.
From the Research
Local Anesthetic Options for Axillary Abscess Incision and Drainage
- The provided studies do not directly compare the use of plain 1% lidocaine and 1% lidocaine with epinephrine for axillary abscess incision and drainage under local anesthetic 2, 3, 4, 5, 6.
- However, a study comparing injectable lidocaine to a lidocaine/tetracaine patch for skin abscess incision and drainage found that injectable lidocaine provided similar analgesia to the patch 3.
- Another study discussed the use of local or regional anesthesia for uncomplicated abscesses, but did not specify the type of anesthetic used 5.
- A review of abscess management noted that incision and drainage under local anesthetic is generally sufficient for immunocompetent patients with no confounding risk factors, but did not discuss specific anesthetic options 6.
- There is no direct evidence in the provided studies to support the use of one type of local anesthetic over the other for axillary abscess incision and drainage.