Anesthesia (Painless Hair Transplantation)
How we minimize discomfort of local anesthetic injection?
Buffering the Lidocaine by adding 7.5% sodium bicarbonate to Lidocaine neutralizes the acidic pH and decreases the pain of injection.
Warming the solution to body temperature lessens discomfort as well.
Cold compress with vibration before injection
We use smallest needle (30G) for infiltration
Hand holding, Talkanesthesia (talking while injecting) and Thai massage for pain distraction
Many people think of anesthesia as being "put to sleep". However, there are other ways of achieving anesthesia, which just means rendering one insensitive to pain impulses. In hair transplantation we use local anesthesia, which, as the name implies, locally deadens (temporarily) the nerves, rather than the whole central nervous system (unconsciousness). This is most desirable because, when using local anesthesia, no pain is felt, the procedure can be done in the office, we avoid the expense and hazards of the hospital operating room and general anesthesia, and the patient is awake throughout the process, and can remain an active participant in decision making and respond to instruction from the physician during surgery.
There is better understanding of the relationship between effective anesthesia and limitation of bleeding or "oozing" during surgery. An inadequately anesthetized, anxious patient may have increases in heart rate and blood pressure that increase risk for bleeding; thus, anesthesia level and physical signs such as heart rate and blood pressure are carefully monitored during surgery.
Local anesthetics are injected into the skin and subcutaneous layers, and/or around larger nerves in the form of nerve blocks.
Nerve Blocks: infiltration of a small amount of anesthetic around a nerve trunk. It’s useful because it can substitute a single injection for a large number of injections and anesthetize a large area with a small amount of anesthetic.
Occipital nerve block, which is in the back of the head, above the neck. When this nerve is blocked, the back of the head (donor area) and crown are numbed; this can be of benefit after the surgery, also, as the donor area may be painful that night.
Donor Area Field Block
4 wheals are initially raised inferior to donor area by injecting anesthetic in the superficial dermis. A 30-gage needle (smallest as available) is then inserted dermally through the previously anesthetized wheal and the anesthetic is injected slightly to the right and then to the left until a solid line of anesthetic is created.
Recipient area anesthesia
Supraorbital nerve block
There is a pairs of nerve exit above the each eyebrows supply the frontal area of scalp. After this nerve block results in hairline and frontal area numbness. It’ll be pretreated with a topical anesthetic cream (5% EMLA) applied to the site of injection under occlusion for one hour combine with vibration will lessen the pain of the block. While waiting for the topical anesthetic to exert its effect, donor area anesthesia may be performed and the donor may be harvested.
However, we do not do the surgery with just the blocks; we always inject locally, wherever incisions will be made. One of the reasons for this is that the blocks may be incomplete at times, and we want the scalp completely numb and unable to feel any pain. The other reason is to add epinephrine (adrenaline) to the area, this has a two-fold purpose: 1) to prolong and intensify the action of the local anesthetic and 2) to constrict the small blood vessels in the area and decrease the amount of bleeding. The importance of diminishing the amount of bleeding, especially in the recipient area, cannot be overemphasized. The less bleeding there is, the more easily and accurately the recipient incisions can be placed; likewise, with minimal bleeding, placement of the FU grafts causes less trauma to the follicles and is generally smoother and quicker.