Avoiding pain during procedure


Local anaesthesia is defined as the localised numbing of a target area. 

Since all tissues are dissimilar, your body processes local anesthetic in a unique manner.

 For instance, redheads tend to require more anesthesia than non-red heads. People with acne prone skin will be difficult to anesthetise. 

And then in some, the numbing agent is removed much faster than in others.  

In some there is so called resistance to anesthesia. The effect may wear off even before the procedure begins.

30.45% patients do not get a hair transplant done since they fear the pain of anesthesia. Most people have been exposed to a dentist in their childhood to treat a  bad tooth or something. This dentophobia manifests itself when they seek any surgical treatment. 

Though doctors are by nature more friendly than dentists, it just does not seem to help!

So a patient may just be a very anxious kinds and the tiniest of stimulus, even touch, can be interpreted as pain.

But most times people have pain since they do not follow very important pre-operative instructions before a procedure.

This casual attitude is more seen in people who are young and adventurous, especially those who are party animals -who keep awake till early morning- even the morning of surgery.

They feel they are going in for a salon treatment little realising that though it is minor, this is no less than any surgical procedure.

So there are certain Dos and Donts that will keep you less anxious and help in calming the nerves and an ultimate smoother, pain free procedure.

The following points if not noted and followed,  will not let anesthesia effect and patients will have a uncomfortable procedure:

  • Sound sleep after 10 PM the previous night
  • No traveling from out of town on the morning of the procedure. Arriving at the clinic one hour before the procedure
  • No alcohol the previous evening
  • No coffee on the morning of the surgery
  • No frequent scratching of your scalp before procedure

Now we shall deal with these one by one-

Sleep & Rest:

You need to be well rested. A tired body and lack of sleep makes you irritable. The slightest of touch is uncomfortable. Leave alone the prick of a needle.

Stress-induced hyperalgesia can be associated with potentiated adrenergic sensitivity of primary afferent fibers as a result of up-regulation of α2-adrenergic receptors and exacerbation of neurogenic inflammation by α1-adrenergic receptors.

If you feel anxious before the procedure this may affect how you respond to anesthesia. Your body tends to interest even the lightest touch as pain.

Though it is always a better idea to have a good night’s sleep and be well rested before the procedure, this can be treated by inhalational anesthesia and intravenous sedation.

Actress reduction protocol is vital for a smooth hair transplant procedure. Stress increases pain by 30.90%


The body’s alcohol content may slow down the action of local anesthesia. It may need larger amounts of anesthetic to be administered thereby restricting mega-sessions if planned.

Moreover, any surgical procedure involves some amount of bleeding to which the body responds by clotting. And alcohol is a blood thinner. It may interfere with FUE hair transplant and cause difficulty in both harvesting and plantation.


Coffee is known to interfere with cognitive functions. Coffee causes increase in heart rate, increased wakefulness, poorer sleep and anxiety in most cases before a procedure. This may cause ‘anesthetic failure’. Therefore it is advised to abstain from coffee 48 hours before the procedure.

Prevent Infection:

 Do not scratch your head often before the procedure. This can cause infection and infection creates a localised higher acidic medium – high pH in issues prevents the effect of anesthesia since it acts only on pH neutral tissues.

In the end, a word about resistance to anesthesia:

Some doctors do not even believe that anything like this even exists.

But those who administer anesthesia routinely, like in my clinic, around 0.1 % of patients that is 0.1% or 1 in 1000 people are recalcitrant to local anesthesia. It is very difficult to anesthetise them.

Clendenen, etal discovered a genetic defect relating that causes resistance to anesthesia. This is since these people have a specific sodium channel in the body, known as sodium 1.5. The affected gene, called SCN5A, produces a protein called NaV1.5, which is a major component of this channel. This is caused by a “missense mutation “ meaning that  that one of the amino acids in the protein is different in people with this type of genetic quirk. It’s not clear what difference is caused by having this mutation, but it could make the sodium channels more likely to remain open, allowing signals to flow to the brain, despite the application of local anaesthetic.

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