local anaesthesia.

[patientgrowth]

whoever said local was just a pinching sensation has obviously never been pinched...that by far has been the worst experience of needles in my life...it would be better to describe that as very long burning sensation across the whole back of the head.

[patientgrowth]

whoever said local was just a pinching sensation has obviously never been pinched...that by far has been the worst experience of needles in my life...it would be better to describe that as very long burning sensation across the whole back of the head.

[HairIsThere]

Hah yeah it's definitely not just a pinch....I thought that whenever they injected the saline into my donor area to raise it up so they could cut it was by far the worst part.

[Bill - Seemiller]

patientgrowth,

 

Pain tolerance thresholds are different for everyone. I must admit the local anesthetic hurt like a bear for my fourth procedure. I don't remember it hurting that much in the past. Perhaps my scalp has gotten more sensitive over the years since I've had so many procedures.

 

Thankfully, the pain doesn't last long and you can't feel anything the rest of the procedure. Of course, there are times the anesthetic needs to be readministered...in which case, you'll experience some additional pain for that.

 

Best wishes,

 

Bill

[Forrest Gump]

I actually did not feel anything more than a slight pinch, but maybe because my tolerance level for pain is quite high.

 

In fact the local anaesthesia injection gave me the exact same feeling that I get when getting a flu shot.

 

However patientgrowth, I am guessing that it might also depend on the doctor and his/her style of injecting. Hopefully, you didn't feel anything for the rest of the surgery.

[Irish-1]

Dr Shapiro's office used a massage machine on my donor area when they were injecting, also had a large hand held one on my back really helped relax you and really didnt feel to much the vibrations kinda mask everything!

[Mop]

Donor and recipient area bloody hurt !

 

Thankfully only for about 15 - 20 seconds each time.

[Dr. Michael Beehner]

There is no question that receiving needle injections into the scalp is a painful thing. I know from first-hand experience, as my first 7 of 9 procedures all featured needle injections with no sedation or narcotics given at all (I had nitrous for my last two).

In my 20 years of practice I have learned a few things about making the pain minimal, largely because I realized what the patient would be going through.

Before reviewing some of the "pearls" I have learned on reducing the pain of a transplant, I do want to emphasize that the pain of needle injections is definitely much greater when done in areas scarred from previous transplant procedures, whether it is in the donor or the recipient areas.

There are seven things I would list:

1) Use some SEDATION if possible. Some states have restrictions on what routes can be used. IV is best, but subcutaneous Versed works wonderfully and gives amnesia and sedation for the procedure. Even Ativan (lorazepam) under the tongue works well. You do have to be certain the patient doesn't drive home though with the drug in his/her system.

2) Use a NARCOTIC. Even a Percocet or Vicodin tablet a half hour before you start raises the pain threshhold and makes everything a little more tolerable. Best of all, narcotics are synergistic with the sedatives in the Valium family and each makes the other work better. Demerol IM is our narcotic of choice in most of our cases.

3) Inject the volume of the local anesthetic SLOWLY. The rapid filling into the tissues of the lidocaine is what hurts more than the prick through the skin. The ultimate in "slow" is a machine commercially sold as "The Wand," which takes awhile but delivers the local very slowly and painlessly.

4) CUSTOM-MIX THE LIDOCAINE AND EPINEPHRINE; In the commercial lidocaine bottles that already have epinephrine in them, there is a preservative also which keeps the epinephrine from breaking down, and that preservative makes the solution very acidic, which makes it sting like crazy. If a nurse gets to the office around a half hour early and pre-mixes the epi into the plain lidocaine syringes before surgery, that sting doesn't happen.

5) Use a SUPRA-ORBITAL BLOCK. You can hold a small ice cube (as we most often do) or use a vibrator at the point near the inner eyebrow to perform this block and it is hardly felt at all. We use Marcaine with epi, as it numbs the frontal and midscalp regions of the scalp for 8 hours in our experience.

6) DISTRACTANTS: As an injection is going on, there are a number of distractants the surgeon can use to help minimize what the patient feels. A small ice cube for cold, pressing for pressure, and the vibration of the nose of a vibrator are three very good ones.

7) Use of the DERMOJET in the donor area. This is an automatic injector device made in France that has been around for over 30 years that allows the surgeon to inject a small amount of 2% lidocaine into the skin in the donor area lightening quick. I have had both needles and this used, and I believe this is far less painful than needles. The skin is a little too dainty and sensitive in the forehead or temples to use this, so I reserve it for the back. Between this in the back and the supraorbital block in front, the whole head is numb and the patient virtually hasn't felt anything.

 

I will repeat again that if you have row upon rows of scars all over your head from old surgeries, then you do have the most difficult scalp there is for numbing without any discomfort. You just have to want it real bad and hope your surgeon uses every trick he knows to minimize the pain. As Bill Clinton once famously said, "I feel your pain."

Mike Beehner, M.D.

[uncjim]

My experience with this has been vast and varied. My first doctor back in the late 1970s was a plastic surgeon who simply jammed the needle into my scalp and slammed..

FULL SPEED AHEAD! I never had felt, or have felt since, that level of pain. It was absolutely excruciating.

 

My second surgeon was Dr. Feinberg. His technique was to administer the anesthetic in small increments and slowly. The experience was like night and day. There was virtually no pain.

 

Finally, my experience with Dr. Wong (who repaired the work by the plastic surgeon and Feinberg) was very much like what I experienced with Feinberg, very little discomfort. There was some along the hairline, where I have extensive scaring due to ancient surgeries from the past, but it paled in comparison to what I had gone through those many years ago.

[FacelessMan]

I'd agree that "pinch" is a euphemism...those needles make their presence known!

 

One pain-management technique that many find helpful is a form of meditation, or mantra. Mine, for example, was "MOTHER@#$%$ #$#ING #$#$!!!!!!"

 

Benjamin

[mmhce]

Apparently different persons have different pain thresholds.

 

My transplant experience was painless, with only a very minimum discomfort.

 

Before, I ever had surgery, I was really concerned about the level of pain, but was pleasantly surprised to find that it was very painless.

 

The worst pain that I have ever experienced was having bracers on my teeth as a kid.

 

The tightening of the bracers was VERY painful and left my teeth numb, with me being unable to chew food. I had to drink soup, with pureed vegetables.

 

My teeth looked blue in the mirror after the tightening.

[patientgrowth]

there is no way pain thresholds vary that much from person to person. i agree that there is some variation, but like one of the posters said it was a pain that i have never in my life experienced. it was a burn like no other. if i have another procedure i will be sure to load up on narcotics.

[alwayswaiting1]

I give injections all day everyday, I'm a dentist. And unfortunately the bad "dental" experience probably transfers over to the HT universe.

 

I don't think the pain threshold is much different on patients. I think the difference in perception is based on the patients past experiences with injections. And when laying on your chest for a HT or on your back for some veneers or a root canal the first thing your going to remember is the last time you got a huge needle jammed into my head or mouth! If it was pleasant, you'll have a much easier time than another patient whose prior experience was more traumatic.

 

Using topical anesthetic also reduces the "pinching" feeling patients experience. Slowly injecting the carpule makes a huge difference in the perception of pressure, and shaking the lip around the injection site also works.

 

I take pleasure in turning new dentaphobic patients around with minimal pain and lots of education about their conditions and the steps they can take to improve them on their own. Taking an active role in your treatment makes it more tolerable. The will also become better patients for future care providers.

 

So hopefully, in my own little way, I'm helping future HT recipients cope with their treatment.

[NewB2HT]

I've had 3 HTs and everytime the pain from the injections has been intense. My Dr. does not like to do them himself...he has his nurse do them and even with all of the above tips on how to reduce pain (Valium, Demerol, Ice, etc...) it still is VERY painful. I wish there were some way to knock me out for that part!

[hair_care]

I felt the injections in the forehead ( recipient) area to be a lot worse than those in the donor area. But if you get a good result at the end of it all, I guess a few minutes of pain is worth it.