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I have myself had two procedures before and feel how you wish to run away he morning of surgery!
This anxiety is normal but in some patients it is borderline panic that sets in.
The process of anesthesia is often considered routine but doctors should note that the patient on the day of the procedure is extremely sensitive to every word, every facial expression , every grimace of the faces of the doctor and his team. He is also sensitive to sights and sounds that can add to his nervousness.
Since most clinics are not approved and accredited medical centers and hospitals, being situated in commercial 2 room tenements, it is not legal for them to use sedation as an effective tool for anesthesia in hair transplant.
Almost 50 different anesthesia protocols exist which suit the facility the doctor works in, his training and the speciality to which he belongs.
Some use Lidocaine others use Bupivacaine with varying amount of epinephrine with or without addition of sodium bicarbonate to lessen the pain of injection of an acidic solution.
Some clinics like mine use premedication in form of oral sedatives to soothen and calm frayed nerves the night before and the morning of the surgery.
Clinics even go a step further by giving short inhalational anesthesia in form of nitrous oxide or stronger IV sedation using Ketamine, Fentanyl or Propofol
In my clinic I have tried almost everything before making my own protocol.
So in brief what are the cornerstones of a painless procedure in my clinic?
1. Pre-medication the night before and the morning of surgery
2. Short- acting Level 2 conscious sedation in selected patients only during the time of injection.
3. Adequate tumescence of donor and recipient areas to lift up the skin from the nerves and vessels below.
4. Taking advantage of the Gateway theory of Pain pathways by a mix of pressure, cold and vibration to minimise pain
5. Buffering the anesthetic solution with sodabicarb
6. Warming the anesthesia solution to 37 degrees Celsius promotes pain free injection
7. Needle size of 30G or lesser
8. Slow ate of injection
9. EMLA Cream 3% (Eutectic Mixture of Local Anesthesia) in women
10. Maintaining a calm ambient peaceful environment with light music and avoiding loud noises in the clinic in the presence of the patient
What my technique does not incorporate-
1. Deep sedation with inhalational gases, long-acting sedatives since patient needs to be in conscious sedation
2. Bupivacaine
3. Nerve blocks
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