Local anesthesia - types and drugs, what operations are performed under local anesthesia at the Mammology Clinic

Advantages and disadvantages

For simple surgical interventions, local anesthesia is indispensable; it has advantages over other types of sensitivity suppression. The drug that is used, an anesthetic solution, acts strictly at the injection site, which helps to avoid severe complications and adverse reactions.

The blockade of pain sensitivity develops on average in 10-15 minutes. The effect lasts for an hour or more, so local anesthesia can reduce pain in the area of the postoperative wound. The patient’s consciousness does not suffer from the action of the local anesthetic, so after the manipulation he can leave the clinic and not be in the ward.

But local anesthesia has its drawbacks. Just a few years ago, it was widely used for operations on superficial tissues and extremities; methods for intravenous administration of drugs with simultaneous application of a tourniquet were developed. Intraosseous anesthesia was widely used. But due to the large number of adverse reactions and complications, these methods began to be used less frequently. And after receiving high-quality drugs for anesthesia, dangerous methods of pain relief were practically abandoned.

The disadvantage of the local method is its limited scope of application. It is effective for anesthesia of mucous membranes, skin and superficial tissues, but is not used for operations on the abdominal and pelvic organs, neck and head.

The infiltration type of local anesthesia cannot be used when operating on malignant tumors due to the possibility of tumor cells entering beyond the wound into other tissues. This increases the risk of developing metastases.

Possible complications and precautions

Despite the fact that infiltration anesthesia is widely used not only in dentistry, this method of pain relief sometimes causes complications:

Hematoma, which may appear due to damage to a vessel by a needle.
Rupture of dental ligaments or tooth deviation. This complication is a consequence of too rapid administration of the drug. To avoid such a pathology, it is necessary to observe the rate of administration of the anesthetic, which is 1 ml/15 seconds.
Trauma to the nerve trunk, which provokes the development of traumatic neuritis.
Periosteum injury. This complication is accompanied by pain and swelling.
Development of infectious inflammation. The reason for this is usually the use of unsterile instruments.
Injury to the muscle tissue located in the infratemporal fossa.
Paralysis of facial nerve fibers. This condition goes away on its own within a few hours. With this complication, the lip may sag and eye reflexes may be absent.
Poisoning of the body. The cause of intoxication is too large a volume of injected anesthetic solution or its injection into a blood vessel.
Allergy. Manifests itself in the form of redness of the mucous membrane, swelling, and difficulty breathing.

In order to avoid complications of infiltration anesthesia, it is necessary to follow a number of rules:

Conduct preliminary testing of the anesthetic to determine an allergic reaction.
The dose of the administered anesthetic drug must correspond to the norm specified in the instructions. If the anesthetic does not have an effect, you need to replace it with another similar medication.
Study contraindications to infiltration anesthesia and the drug used.
When administering the anesthetic, do not make sudden movements so as not to injure the soft tissues.
If you are afraid of the needle, you can use preliminary application anesthesia. Before making the injection, the doctor will treat the area of the mucous membrane with an anesthetic gel.
In order to prevent the needle from entering a large vessel, the doctor pulls the syringe plunger towards himself. If blood appears in the syringe, this indicates an error. In such a situation, the specialist moves the needle to another place.

In order not to encounter the unpleasant consequences of infiltration anesthesia, you need to seriously approach the issue of choosing a clinic and specialist. After all, it is due to medical errors that most complications arise. In our clinic they are extremely rare. We are proud of the level of training of our specialists and invite you to undergo safe treatment in a comfortable environment.

Types of local anesthesia

Several types of local anesthesia are used in surgical practice, but some of them already have historical significance. The main methods of pain relief are the following:

superficial anesthesia - pain sensitivity is suppressed after the anesthetic comes into contact with the surface of the tissue, most often used to anesthetize the mucous membranes. The anesthetic solution is applied by lubrication or irrigation, the effect lasts for 10 minutes;
infiltration anesthesia - anesthesia by impregnation, or infiltration of tissue layers with a local anesthetic. The technique allows you to control the depth and width of the drug injection, depending on the intended incision. The medicine is injected carefully first into the subcutaneous area until the lemon peel effect appears, then the needle is gradually moved inward and an additional dose of the drug is injected;
anesthesia according to Vishnevsky is an improved version of the infiltration method. A weak anesthetic solution is injected layer by layer under high pressure. A tight creeping infiltrate forms in the tissues. It spreads through the interfascial spaces and disrupts the conduction of impulses along the nerves passing through them. After cutting the wound, the liquid gradually flows out of the wound, so there is no risk of its absorption into the systemic circulation and the development of toxic reactions;
conduction anesthesia is the essence of the method in anesthetizing a specific area of the body innervated by the nerve trunk. An anesthetic drug is injected into the tissue around the nerve; the technique is used for operations on the limbs;
spinal anesthesia - the analgesic effect is achieved by injecting an anesthetic drug under the choroid of the spinal cord, the main place of drug administration is the lumbar region, and pain sensitivity in the pelvic organs and lower extremities disappears. But tactile sensitivity does not suffer;
epidural anesthesia is a type of anesthesia in which a local anesthetic is injected into the space over the dura mater of the spinal cord, and a puncture is also performed in the lumbar region. Sensitivity is lost after 15-20 minutes, but the effect lasts for 3-4 hours. The use of this type of anesthesia allows you to resume activity early after surgery;
bone anesthesia is a type of anesthesia in which an anesthetic solution is injected into spongy bone. Currently, it is practically not used; previously it was used for operations on the limbs.

Preparations for local anesthesia

Local anesthetics are drugs from the group of neurotropic drugs that completely or partially block the flow of signals along nerve fibers from the site of painful manipulation or surgery to the central parts of the nervous system.

The peculiarity of the action of drugs is related to their spectrum of action. They suppress the transmission of signals along myelinated type A nerve fibers, which transmit feelings of pain, smell, and temperature. Tactile sensations are carried out through type B fibers, and anesthetics do not affect them. Therefore, when using local anesthesia, the patient does not feel pain, but feels the touch of the doctor and the surgical instrument.

Local anesthetic drugs are divided into 3 groups depending on the duration of action:

short-acting - the effect lasts 30-50 minutes, these include Novocain;
average duration - up to 90 minutes, these are drugs Lidocaine, Trimecaine, Ultracaine;
long-acting – the effect lasts more than 90 minutes, typical for Bupivacaine.

Local anesthetic drugs affect the electrochemical processes of ion exchange in nerve endings. Medicines work effectively in an alkaline environment and tissues rich in lipids, which include nerves. But the analgesic effect decreases with severe tissue inflammation, which is associated with a transition of pH to the acidic side.

The effect of local anesthetics is enhanced by drugs that affect vascular tone. Therefore, they are often combined with adrenaline to prolong the effect. This allows you to reduce the dose of pain medication and avoid toxic reactions.

What is operated under local anesthesia in mammology?

The mammary glands are located superficially, they do not have muscles and large nerve trunks. Breast tissue is loosely located; in young women, glandular tissue predominates, which is replaced by fatty tissue with age. Therefore, for numerous manipulations and operations, local anesthesia can be used.

In mammology, anesthesia is used to perform invasive diagnostics, which include breast tissue biopsy. To do this, a local anesthetic is injected with a thin needle into the area of the intended puncture. After 10-15 minutes, the doctor can take breast tissue for examination without fear of causing pain to the patient.

Local infiltration anesthesia in mammology is used for small, minimally invasive operations. A woman can undergo puncture of a breast cyst after preliminary infiltration anesthesia. A similar approach can be used when removing small benign breast tumors.

In men, anesthesia is used during surgery for type 1 gynecomastia, when the size of the gland is still small. Infiltration of tissues increases hydrostatic pressure in them, thanks to which the doctor can easily separate pathological tissues from healthy ones.

Is it painful to do local infiltration anesthesia?

When performing anesthesia, a standard disposable syringe with a thin needle is used. Whether local anesthesia is painful depends on your general pain threshold. The patient feels the moment of the first puncture of the skin and a slight feeling of fullness when the drug is administered. After the medication begins to act, sensitivity disappears. The doctor checks how effective the injection is by tapping the skin. In response, there is a feeling that the injection site has become woody.

After the end of anesthesia, sensitivity gradually increases, and a slight tingling sensation may appear. If anesthesia was performed for surgery, pain in the wound area begins to bother you, which can be reduced with the help of non-steroidal anti-inflammatory drugs.

Sedation

Sedation is a “dream-like” state of peace, calm and equanimity that is induced by a relatively small dose of drugs typically used to administer general anesthesia.

Sedation allows the patient to relax physically and emotionally during any medical examination or procedure that may be unpleasant or painful (for example, indications for sedation may include endoscopic examinations, biopsies, radiological studies, dental treatment, etc.).

The state of sedation, on the one hand, creates good conditions for the surgeon’s work, since the patient, being half asleep, is quite relaxed. On the other hand, sedation in its depth is a relatively superficial state, so that if necessary, the patient is able to follow the instructions of the operating surgeon at any time, which is, of course, very important.

Sleep during sedation is not very deep, so the patient’s breathing function, unlike general anesthesia, is usually not impaired. After sedation, the patient will either remember nothing at all about the procedure performed, or have very little memory of the past.

Technically, sedation can be performed both in the operating room and outside of it. Despite this apparent simplicity, sedation requires a very careful and scrupulous approach - the same as other types of anesthesia.

Contraindications for local anesthesia

Local infiltration anesthesia is a relatively safe method of pain relief. But to reduce risks during and after surgery, it is necessary to take into account contraindications to the use of the method. The main ones are the following:

allergy to anesthetic - if earlier during dental treatment under local anesthesia an allergy to an anesthetic appeared, then during breast surgery the effect will repeat, and may be more pronounced, up to anaphylactic shock;
psychomotor agitation and mental illness, reaction to the administration of an anesthetic and the surgical procedure itself can cause unpredictable behavior of the patient;
during operations on malignant tumors - when infiltration anesthesia does not allow compliance with the ablastic rule;
during long operations that require the use of microsurgical equipment;
during interventions on areas of the body with a pronounced vascular network, for example, on the neck.

If local anesthesia is contraindicated, general anesthesia is preferred.

If anesthesia does not work

Despite the proven effectiveness of modern painkillers, sometimes situations arise when anesthesia does not work on the patient. This may be due to the following reasons:

Drinking alcohol on the eve of a visit to the dentist is often an obstacle to pain relief, since the ethyl alcohol contained in the patient’s blood blocks the action of the anesthetic;
Taking an excessive dose of painkillers before dental treatment can also interfere with the normal action of the anesthetic. It is important that the patient's self-administered pain medications are largely eliminated from the body before visiting the dentist;
It is also rare that a patient is individually immune to a particular drug.

In each specific case, the doctor will find out why the anesthesia is not working and offer alternative options. It is possible to postpone treatment to another day.