Lidocaine with epinephrine. Nadia G. Mohyuddin, MD, an associate professor of clinical otolaryngology at the Houston Methodist Research Institute in Texas, said that shortages of 1% lidocaine with epinephrine have been a problem because it’s such a commonly used item for in-office otolaryngology procedures, including obtaining small biopsies in the mouth or tonsil region or removing skin lesions.
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September 2022“Not having lidocaine with epinephrine is challenging,” she said. “You can still provide appropriate anesthetic to a patient by giving them a lidocaine injection, but you may not be able to get the degree of hemostasis or blood control as you would if it had epinephrine in it.
“Usually, these procedures aren’t very bloody to begin with, however” she added. “You can still most likely be able to obtain the biopsy that you need and do the procedure with just plain lidocaine if you had to.”
Douglas D. Reh, MD, the director of clinical research at the Centers for Advanced ENT Care, LLC, with locations in Baltimore and Hunt Valley, Md., also experienced shortages of lidocaine with epinephrine, which he and his colleagues responded to by conserving and rationing these topical anesthetic agents. “We had to be very conservative in how we used our injections,” he said, citing, as an example, storing unused syringes that were still sterile in refrigerators so that they could be saved for another patient.
(As of August 9, 2022, the American Society of Health-System Pharmacists Drug Shortages List [bit.ly/3R4O4ev] included 19 different products containing lidocaine with epinephrine, all manufactured either by Pfizer or Fresenius Kabi. Formulations included 0.5%, 1%, 1.5%, 2% strengths in 20-mL to 50-mL vials.)
Tympanostomy tubes. Dr. Reh added yet another shortage to the list: his preferred tympanostomy tubes for in-office use, which he found to be very frustrating. “I definitely had to do some juggling of supplies with my surgery center for several months, which could have easily caused some delays,” he said.
To prevent future shortages, should there be federal reserves of critical medical equipment and supplies, “like we have for vaccines, or beyond that, for grain and gas and other essentials?” Dr. Hansen asked. “Maybe that’s something that we as head and neck surgeons need to look at. Because what if the next shortage is of bone cement or some other key tool that we use to treat our patients surgically? That would really hit home hard. Like it or not, we do have an important stake in keeping the supply chain as intact as possible.”