Local Anesthesia Shortages—Adapting to a New Way of Life

To the Editor Over the past several months, there have been increasing numbers of medication shortages throughout North America, exacerbated (but not solely caused) by Hurricane Maria's effect on the pharmaceutical manufacturing industry on the island of Puerto Rico. Medication shortages are affecting health care facilities in new ways on a weekly basis without imminent solutions. In particular, within the field of facial plastic and reconstructive surgery, we have noted a shortage in formulations of lidocaine and bupivacaine. We have received various sizes of bottles of these anesthetics in varying concentrations with varying concentrations of epinephrine, further complicating our "typical" anesthesia protocol. Our clinic's typical anesthesia was a 1:1 mixture of lidocaine, 1%, with a dilutional ratio of 1:100 000 and bupivacaine, 0.5%, with a dilutional ratio of 1:200 000.