The importance of pain control in hair transplantation cannot be overemphasized. Adequate preoperative sedation to raise pain threshold, reduce anxiety, and induce amnesia is fundamental to minimizing operative pain. Injecting local anesthetic causes majority of the pain which is associated with the procedure. Once initial anesthesia is achieved, proper maintenance of anesthesia is of paramount importance especially with the trend toward larger numbers of grafts being performed in one session with prolonged operative times. The choice of infiltration technique, optimal field blocks and nerve blocks,local anesthetic agent, proper hemostasis, timely repetition of anesthesia, and use of analgesics intraoperatively, with the goal of maintaining the patient pain-free during the procedure, are fundamental.
At our centre we use short acting and long acting local anaesthetic agents like lidocaine and bupivacaine which are diluted with normal saline and later adrenaline is added to achieve vasoconstriction. The use of long acting local anesthetic alongwith adrenaline reduces the need of frequent top ups thereby reducing drug toxicity.
Prior to the procedure, test dose is administered to the person to rule out any possibility of hypersensitivity reaction. 26 gauze insulin needles are used to administer anesthesia that causes minimal prick pain. Additionally sodium bicarbonate is added to xylocaine to counter its low pH which again helps us to minimize pain.
Prior to local anaesthesia we administer regional blocks which anaesthetizes the nerve which supply a major portion of the donor as well as the recipient area. For the frontal hairline and centre we can block the supraorbital and supratrochlear nerves. For the donor area we give a regional block by blocking the lesser occipital and greater occipital nerves Local anaesthetics are administered in a titrated manner starting with only 0.1 ml at multiple places to begin with and then topping up the same points with more anesthesia.
So far no episode of any kind of anesthesia related complication has been encountered at our centre yet we are fully equipped to manage any adverse reaction due to local anaethesia.
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