Since there are a number of painless or pain free cosmetic procedures, the different types of anesthesia used for each of them can be confusing. The standard thinking was that any invasive procedure required general anesthesia while a minimally invasive procedure near the surface of the body could be done with local anesthesia only. However, surgeons are pressing the boundaries of what is invasive and what requires general anesthesia. All of these changes often leave patients in the dark.
We begin with a little lesson in pain and anesthesia. We experience pain when pain receptors are activated sending electrical nerve signals to the brain. If we can interrupt this signaling process, we can stop pain. In general anesthesia, the body loses consciousness and the pain pathways are turned off at the brain level. With local anesthesia, a chemical is infused into the tissues that block pain receptors and nerves near the drug infusion site. The patient, in this case, remains completely conscious.
With epidural anesthesia, the pain signals are blocked halfway in their travels from skin to brain, that is, in the spinal cord. As with local anesthesia, a patient can be pain free (in the lower half of the body) and awake during epidural anesthesia. Twilight anesthesia, on the other hand, takes a patient to the verge of consciousness through the use of an intravenous (IV) carrying pain killers and sedatives. Patients do feel pain during twilight anesthesia, but do not remember it or care much about mild pain because of the sedation.
If a local anesthetic can penetrate deeply enough to block pain receptors that the surgeon may disturb during surgery, local anesthesia can be used. Consider tumescent liposuction, for example. The skin is filled with a solution that contains a local anesthetic, such as lidocaine. The patient is awake, alert, and usually pain free. If the lidocaine does not reach all areas of the tissue there will be pain, however, even with oral or IV pain killers.
Tummy tuck procedures usually remove tissues that are too deep for local anesthetic to penetrate. This is especially true for tummy tuck procedures that involve the stomach muscles themselves. On the other hand, minor mini tummy tuck procedures may only require local anesthesia, if only a small amount of tissue is removed. Alternatively, an epidural anesthetic may be used to keep the patient awake and pain free during tummy tuck surgery.
The bottom line is that the choice of anesthesia is a difficult and complex one. General anesthesia is more expensive and associated with greater risk than local, but assures a painless procedure. On the other hand, local anesthesia is less expensive and faster, but may not block all of the pain of increasingly invasive surgical procedures.
An epidural can provide profound pain relief, but the patient’s head must remain elevated to prevent the anesthetic from moving toward the brain. Anesthesia should be discussed with your surgeon and prospective anesthesiologist prior to surgery. Patients often have strong preferences when it comes to anesthesia and these wishes will be taken into account. However, everyone’s goal is to make the surgical procedure as painless as possible, and your cosmetic surgeon will choose the method that best achieves that result.