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

There is a paucity of data providing direct comparison of outcomes, complications, and costs between general and local anesthesia in cutaneous surgery. Analyze the literature from dermatologic and other specialties to compare outcomes, risks, and costs of general and local anesthesia. 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. 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. These data cannot be seamlessly applied to all cases of cutaneous surgery. Local anesthesia techniques provide outcomes equal to or better than general anesthesia and with significantly lower costs.