Can FUE HT be done without using ephinprine(adrenaline)?

[AK74]

Hello all,

I am new here. In last 2 weeks, I have got tons of information on hair restoration and transplant from this forum. Thanks to all the members for your regular posts and support to fellow members.

I am 47 yrs old. I am a NW 3A and have hair loss in the front and mid scalp. I consulted a top clinic in India and based on pictures, they have recommended FUE of2400-2600 grafts.

I have a history of ventricular tachycardia (heart rhythm prob). I am clinically stable for last 4-5 yrs through medications. I have checked with my cardiologist regarding HT. He has given go ahead for the HT procedure but said that adrenaline should not be used with the local anesthesia, as that would be a risk. 

Can anyone here advise whether we can do the FUE HT with local anaesthesia (Lidocaine+Bupivicaine) but without any ephinphrine(adrenaline) ? 

[Future Hair Doc]

That's a great question...the epinephrine is used to prevent the anesthetic from going where it's not supposed to go by constricting blood vessels and also lowers bleeding too. I bet @DrTBarghouthiwould know the answer 

[DrTBarghouthi]

Thanks for the mention Doctor. Yes epinephrine tends to be used along with the local anesthesia to cause blood vessels to constrict and hence allow the local anesthesia to work locally in a more effective and safer way. This makes it possible to give a higher safe volume and allows it to last longer. I also tend to dilute more epinephrine in a very small volume along with the tumescent fluids. 
 

From an anesthesia point of view, you can exclude epinephrine but that means your maximum dose will be much lower, so maybe give anesthesia to small regions and spread out the time of administration and better off even the total amounts of grafts per day. So do less numbers per day and inject small areas, do the extractions and then inject a new area etc. This gives the body time to metabolize the drug since your safety dose is lower than if used with epinephrine. 
As for tumescent use, I would check with the cardiologist if a very diluted concentration is safe as it is quite helpful to reduce the bleeding from site creation and extraction. If this is not allowed as well, I would tend to attempt without epinephrine but I tell the patient that if bleeding tends to be more than what is normally expected, then we will have to stop the procedure.

I hope that is clear. 

[AK74]

Thank you very much @Dr. Suhail Khokhar for taking this up

Thank you very much @DrTBarghouthi for your detailed explanation.

I have one query. While the first benefit is universally acknowledged that epinephrine allows a higher safe dosage and longer duration of anaesthesia, i found some studies saying that the second benefit of lesser bleeding is more pronounced in first 30 mins and this effect diminishes with subsequent injections.

Can you please comment on this based on your experience?

[DrTBarghouthi]

Yes it is true that vasoconstriction is not of a long duration. That’s why we top up the effect using diluted injections with tumescent which is more frequently injected (in each zone we work with). Moreover, we really want the bleeding controlled while working so 30 mins is good enough while maximum visibility is important. After that your normal body clotting mechanism is sufficient to control. 

[gillenator]

Very informative answers provided!

It's very important for each and every patient to provide the doctor with a comprehensive medical history that includes all current medications...this should be completed at the time of consultation IMHO.