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.

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 used for topical anesthesia

Local topical anesthesia often contains the same types of active ingredients as injection anesthesia (lidocaine, dicaine, bumecaine, etc.), but in higher concentrations. The composition is often supplemented with antiseptics, inflammatory process blockers, and flavorings. The main forms of release are cream, gel, ointment, spray, aerosol.

The entire list of available tools can be divided according to the principle of action:

cauterizing agents - acid-containing preparations that can seal dentinal tubules and close nerve endings from external influences;
dehydration compounds - preparations based on carbonic acid salts dehydrate tissue, constricting blood vessels and depriving the tissue of sensitivity (more suitable for superficial manipulations such as brushing teeth and removing tartar);
analgesic liquids with a high concentration of anesthetic compounds block the conduction of peripheral nerve fibers (the most common group of anesthetics);
preparations of physiological effects based on strontium, fluorine, sulfides - block the transmission of impulses to nerve endings (such drugs often have an additional therapeutic effect and can be used to treat and strengthen enamel, protect against caries);

ATTENTION! Despite the safety and simplicity of the method, using topical anesthetics yourself at home is undesirable. In each individual case, the dentist selects and prescribes the drug individually, taking into account the source of pain and the personal characteristics of the patient.

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.

Local anesthetics in dentistry –

At the moment, the most modern anesthetics in dentistry are drugs based on articaine hydrochloride. We have already said above that this group also includes Ultracain, Ubistezin, Septanest and others. Anesthetics of the articaine series are more effective than lidocaine - 1.5-2 times, and Novocaine - 5-6 times. As for the duration of anesthesia with drugs based on articaine, it will depend, among other things, on the concentration of vasoconstrictors in the anesthetic composition.

Vasoconstrictors, due to the narrowing of blood vessels at the injection site, can reduce the leaching of the anesthetic, and this leads to an increase in the depth and duration of anesthesia. Manufacturers always produce the same anesthetic with different concentrations of vasoconstrictors. The following concentrations of the vasoconstrictor epinephrine are usually used - 1:100000, 1:200000 + option and without a vasoconstrictor at all. This allows for optimal use of the drug in patients of different risk groups. The most commonly used anesthetics are:

1) Anesthetic “Ultracaine” –

The anesthetic Ultracaine is produced in France in 3 possible versions, which will differ in the presence/absence of epinephrine in the composition, as well as its concentration. A separate article is devoted to this most popular and safe anesthetic (link above). Forms of release of ultracaine:

“ultracaine DS forte” (with epinephrine concentration 1:100,000),
“ultracaine DS” (with an epinephrine concentration of 1:200,000),
"ultracaine D" (without epinephrine, without preservatives).
Read also: White formations on the throat: how to treat

2) Ubistezin - instructions for use

Good anesthetic, produced (Germany). The composition of Ubistezin is absolutely no different from similar forms of Ultracain, and there are only different release forms. The first option is “Ubistezin” (with an epinephrine concentration of 1:200,000), and the second is “Ubistezin forte” (with an epinephrine concentration of 1:100,000).

Read a detailed description of the anesthetic and its indications for use here: → Ubistezin forte - instructions for use (PDF)

3) Septanest: instructions for use

Septanest has been used in dentistry for a very long time. This anesthetic has 2 release forms with adrenaline concentrations of 1:100,000 and 1:200,000. But compared to ultracaine and ubistezin, this anesthetic contains a slightly larger amount of preservatives (sodium metabisulfite and EDTA), which is undesirable in a number of patients, for example, with frequent allergic reactions, bronchial asthma, etc.

Read a detailed description of the anesthetic and its indications for use here: → Septanest 1:100,000 – instructions for use (PDF)

4) Scandonest: instructions for use

Anesthetic from Septodont (France) based on 3% Mepivacaine.
Does not contain vasoconstrictor components or preservatives. Scandonest in dentistry is used mainly only in patients at risk who cannot take anesthetics with adrenaline and epinephrine, as well as in patients with bronchial asthma. A complete analogue of Scandonest is the anesthetic Mepivastezin, produced (Germany). Read a detailed description of the anesthetic and indications for use here: → Scandonest - instructions for use (PDF)

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.

About carpuled anesthetics, syringes and needles for local anesthesia

Dental centers, including ours, use not ampoule, but carpule anesthetics of the latest generations. The drugs are in special containers - cartridges, which are inserted into a carpule syringe. The thinnest disposable needles are used for syringes. Carpuled anesthetics are used by doctors taking into account pharmacological characteristics, including additives.

The carpule syringe is easy to use, allows you to take an aspiration sample, insert a needle and inject with one another. It can be easily sterilized in an autoclave, which is used by most dentists. Ease of use reduces the risk of intravascular injection and needle deviation in tissue from the chosen trajectory.

The needle is fixed using a thread of European or American standard. Naturally, all consumables are absolutely sterile, their tips are in excellent condition - sharpened and specially coated, making the injection less traumatic.

Advantages of anesthesia using carpuled anesthetics:

Absolute sterility. The ampoule does not open, and therefore there is no contact of the solution with the air.
Exact dosage. All drugs, including those that protect the anesthetic from decay, are in the required dosages.
No pain. The needle of the syringes is thinner than regular ones and has a special angle and sharpening pattern, which reduces the pain sensation to almost zero.

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.

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.