Anesthesia in Hair Transplant

In the past, the 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 an anaesthetic agent for surgery are 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.

LIDOCAINE

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 a requirement of 1% lidocaine in the donor area and 2% in the 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.

BUPIVACAINE

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

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 a tumescent solution containing bupivacaine. This combination facilitates the 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:

  1. Simultaneous physical stimulation by using vibration while injecting anaesthesia
  2. Cooling which causes numbness of nerves which carry pain sensation
  3. 30G needle which reduces the prick sensation
  4. Rate and depth of injection is optimized to reduce pain
  5. The 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.

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