Anesthesia in Hair Transplant
In the past, surgical pain was alleviated by bizarre methods such as bullet’s bite and shots of alcohol. Fortunately, science progressed to its current state where we have a wide range of safe and effective anaesthetic agents to choose from as per our requirements. Anaesthetic agents reduce pain and anxiety. Hence, the patient becomes more comfortable and calm during surgery.
Hair transplantation is a minor surgery. Proper selection and administration of anaesthetic agent for surgery is important. The operating physician should be aware of dose, action, duration and potential toxicity.
At our DHT center, lidocaine and bupivacaine are used for providing local anaesthesia for hair transplantation.
It is a short acting anaesthetic agent commonly used in hair transplantation.It has a quick onset of action of 2-4 minutes. The effects last for 30-60 minutes. The duration of action is longer when combined with adrenaline i.e. 120 minutes. There is requirement of 1% lidocaine in donor area and 2% in recipient area. The recommended total daily dose of lidocaine is 300mg (maximum) in cases of tumescent anaesthesia. The amount can be increased when combined with epinephrine to 500mg.
It is a long acting anaesthetic agent used commonly in hair transplantation. Bupivacaine has a slower onset of action as compared to lidocaine and has a longer duration of action (120-240 minutes). Usually for field blocks, 0.25% bupivacaine is used while for peripheral blocks concentration used is 0.5%.
Buffering refers to neutralizing a solution. This is an important step in order to reduce pain associated with infiltration of anaesthesia.
Our Technique of Local Anesthesia Administration
There is a wide variation in preference of anaesthesia amongst surgeons. In our clinic, we try to give maximum pain relief while obviating side effects of anesthesia. Hence, we combine local anaesthesia given in a ring block along with tumescent solution containing bupivacaine. This combination facilitates prolonged action of anaesthesia making the surgery virtually painless and comfortable along with good hemostasis i.e. minimal bleeding. This combination has also helped us to use low dosage hence avoid potential toxicity.
Factors to promote painless injections
We try to make the surgery as painless as possible by incorporating the following measures:
- Simultaneous physical stimulation by using vibration while injecting anaesthesia
- Cooling which causes numbness of nerves which carry pain sensation
- 30G needle which reduces the prick sensation
- Rate and depth of injection is optimized to reduce pain
- Environment of OT and surgery is made comfortable and friendly
Please refer to our Article – Limiting Pain From Injections in Hair Transplantation for more details.