General anesthesia usually is necessary in children. It also should be the mode of anesthesia in cases involving large rotational flaps, such as the Mustarde cheek rotation flap. However, because most lid tumors occur in the older population, there may be hazards in using a general anesthetic approach. Therefore, most small or medium-sized lid tumors may have to be excised under local anesthesia. Even if a lid tumor excision has been planned under general anesthesia, a small infiltration of 2 % lidocaine with adrenaline (epinephrine) 1:200,000 solution to the surrounding area helps in two ways. First, it reduces perioperative oozing through its vasoconstrictive effect, and second, it reduces postsurgical pain following general anesthesia.

Local anesthesia is adequate for most adults and is preferred for most types of biopsies, as well as for excision of small to medium-sized lid tumors. Adequate anesthesia may be obtained with a simple subcutaneous injection of 1.5–2 mL 2 % lidocaine hydrochloride with adrenaline (epinephrine) 1:200,000 solution across the breadth of the lid. A lidocaine-bupivacaine mixture provides adequate anesthesia for a slightly longer duration. Approximately 0.5–1.5 mL of lidocaine hydrochloride is injected subcutaneously across the lid at the level of the lid crease.

Supratrochlear, supraorbital, lacrimal, infratrochlear, zygomaticotemporal, zygomaticofacial, and infraorbital nerve blocks provide relatively good localized sensory anesthesia without causing much localized tissue edema at or around the site of dissection, especially during lid reconstruction.