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.

What preparation is needed?

Before general anesthesia, a special examination is required:

General blood analysis
Coagulogram
General urine analysis
Biochemical blood test (sugar, bilirubin, urea, creatinine, total protein)
Antibodies to hepatitis B, C, HIV, Microreaction not older than three months
EGC not older than a month
Fluorography of the chest organs over the past year
Blood for blood type and Rh factor

When the necessary tests have been collected, the anesthesiologist must examine the patient along with the examination results, ask the patient about important aspects of his health, and comment on the upcoming procedure. Given the fact that muscles relax during medicated sleep, the risk of stomach contents flowing into the respiratory tract increases. That is why planned interventions are carried out on an empty stomach.

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.

How is the period after?

In the first minutes after waking up, the patient may experience some discomfort, however, the unpleasant sensations quickly fade away and after an hour and a half, patients are in their usual state of mind. Sometimes, after waking up, patients may experience nausea and vomiting. That is why it is recommended to take a short pause between waking up and the first intake of water and food. Fortunately, if the above-described discomforts occur, they are quite fleeting.

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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.

Horror stories about anesthesia

No one will ask a traumatologist about gynecological diseases. However, questions about anesthesiology are asked to doctors of any specialty, who, as a rule, understand it no more than other ordinary people - anesthesiology is a very specific subject. Once I came across this: a patient came for tooth extraction under anesthesia, paid for the extraction and anesthesia, but refused the anesthesia, because a relative (therapist) said that EVERYONE dies from anesthesia.

Patients who undergo operations under general anesthesia write with pleasure in various forums how afraid they are of “general anesthesia,” and a chorus of well-wishers echoes them: “yes, yes, anesthesia is like dying a little,” “anesthesia has a lot of contraindications,” “maybe allergic shock!” It seems that you can do without anesthesia and there is no need to monitor the patient’s somatic condition during the most complex and traumatic interventions. At the same time, no one writes that pain has a very, very strong effect on health, that not everything can be tolerated, that a surgeon is a person who only performs an operation, and an anesthesiologist is precisely the specialist who cares for the patient.

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.

Sedation

Fear. This is the feeling that most people have when they think about visiting the dentist's office. Under a feeling of fear, movements become constrained, and especially impressionable people may even lose consciousness during or immediately before the procedure.

For emotional and physical relaxation, sedation is used in dentistry. Through a special mask, the patient inhales an oxygen-nitrogen mixture. Thanks to this, a feeling of calm appears. This procedure is in demand in pediatric dentistry, since it is usually difficult to calm a small child before the procedure.

If the patient has respiratory diseases or sensitivity to the components of the gas mixture, sedation is given intravenously. But this method is used extremely rarely.

Sedation in no way replaces anesthesia. It is used as an adjunct to calm and relax the patient. At the same time, he remains conscious throughout the session, and the effect of the gas wears off as soon as the mask is removed.

However, it is worth noting that despite all the seemingly positive effects of sedation, it is better to do without it. A clear mind and fresh consciousness allow you to quickly respond if necessary if something goes wrong.