Regional blocking techniques have proved to be invaluable in anaesthesia and as with any procedure, regardless surgical or non-surgical, a good understanding of anatomy is imperative. The advent of facial surgery and more complicated aesthetic facial procedures has increased the demand for anaesthesia support; therefore, a practitioner should always be equipped with a fail-safe method, and be aware of the effectiveness and shortcomings of all the various modalities available in his/her “tool box”.
Local Anaesthesia: Nerve Blocking
The use of local anaesthetics can enable a proliferation of procedures to be performed in office setting with the patient awake. Not only do local anaesthetics minimise exposure to general anaesthesia and the associated risks, local anaesthesia is also a good alternative for a more economical method of delivering healthcare to the advantage of society as a whole.
There are different methods of administering local anaesthesia, and these include, but not limited to, infiltrative techniques, topical application, tumescent injection and nerve blocks. In the case of nerve blocks, local anaesthetic agent is delivered into the region of the nerve trunk and these nerve blocks represent a valuable tool when it comes to surgery. There are numerous peripheral nerves that lend themselves readily to blockade, and some of these include the infraorbital, mental, supraorbital and supratrochlear, external nasal, auriculotemporal, as well as greater auricular blocks. The most commonly employed blocks are infraorbital, mental, supraorbital and supratrochlear; the blockade of these areas can provide adequate anaesthesia to a large area with minimal discomfort to the patient.
Image credit: https://journals.sagepub.com/doi/pdf/10.1177/0748806817690986
In a recent study published in 2017, the authors observed that 77% out of 50 patients finds nerve block to be the least painful method as compared to the 21% who finds topical anaesthesia to be less painful while the remaining 2% has no preference. In the same study, it is observed that 56% of the 50 subjects preferred nerve block as compared to 33% who preferred topical anaesthesia, with the rest of the 10% having no preference.
Although the study was conducted to find out patients' preferences for pre-procedural anaesthetic prior to facial cosmetic injectable fillers using hyaluronic acid (HA) - the use of HA or fat grafts do not change the basic fundamentals of anaesthetic for facial cosmetic injectable filler procedures in terms of effectiveness and purpose.
Advantages of Nerve Blocks
Only with an appropriate understanding of the anatomy and nuances of nerve blocks, can a practitioner then be able to confidently perform a procedure with minimal risks and maximise patient comfort. There are many advantages of regional nerve blocks, including the use of minimal local anaesthetic (usually 1-3ml), which in turn, can effectively reduce the chances of toxicity yet providing a good coverage of a large area while preventing distortion of the operative site.
Some advantages of employing nerve block for procedures are:
Better pain control than intravenous narcotics
Less need for systemic opioids (narcotics)
Less nausea experienced by patients
Easier breathing resulting from better pain control
Easier participation in physical therapy
Additionally, if performed correctly, nerve blocks not only significantly minimises pain to the patient due to the minimal number of injections required, but also less nausea from regional blocks with patients generally awakening faster than most other methods of anaesthesia. Furthermore, regional blocks can also be used to relief pain post-surgery by providing better pain control than intravenous or intramuscular opioids (narcotics) and potentially improve recovery in some patients.
Potential Complications and Risks of Nerve Blocks
As with any modality of treatment and administration, there are potential complications and risks when administering the nerve block method, no matter how exceedingly rare it may be. The most commonly reported complications include intravascular injection, vessel trauma causing ecchymoses and hematoma, or nerve injury leading to dysesthesias and paresis. Unlike the infiltration method of local anaesthesia which is generally performed with the addition of epinephrine, nerve blocks may also lead to vasoconstriction of the adjacent blood vessels, thus requiring additional local anaesthetic with epinephrine be infiltrated in the operative site to help achieve homeostasis.
Other potential complications and risk of nerve blocks are:
Intravascular injection causing local anaesthesia toxicity
Injection to nerve fibres
Vessel trauma causing ecchymoses and hematoma
Nerve injury leading to dysesthesias and paresis
While nerve blocks are safe and have been successfully utilised for a variety of applications, it is important that a practitioner fully understand the limitations as well as all potential complications and risks.
Nerve Block for Facial Fat Grafting
The administration of injectable fillers, such as HA and fat grafts can be a painful experience for patients wishing to improve their facial aesthetics. To minimise patient discomfort, anaesthetic is often used in various forms, and as facial cosmetic surgery becomes increasingly popular in modern societies all around the world, demand for outpatient, minimally-invasive, and painless procedures increases, leading to a linear increment in the use of injectable facial fillers to treat mild facial defects, ageing, and volume loss. This is specially true for fat grafting procedures as it continues to gain significant popularity as alternative to HA due to their safety, efficacy, better longevity, and ability to be applied in office settings.
In the pursuit to provide the most comfortable and pleasant experience for patients, not only must a practitioner be proficient in the techniques of the procedure, but also in the administering of the right anaesthesia method, regardless in office-based, out-patient or surgical setting.
This week, IFAAS faculty Dr. Sung, demonstrates his exclusive technique in Administering Local Anaesthesia using the Nerve Block method for Fat Grafting for the Face. This technique is also taught at our upcoming Liposuction & Fat Transfer for Face & Body under Local Anaesthesia Mini-Fellowship happening on October 7-8, 2019 in Seoul, South Korea:
Hope you have enjoyed the article & video! Stay tuned for our future posts about more techniques and information related to our advanced aesthetic and cosmetic training courses!
Learn the Most Advanced Techniques in Liposuction & Fat Transfer for Face & Body under Local Anaesthesia at our IFAAS Hands-On Mini-Fellowship happening in Seoul, South Korea on 7-8 October 2019!
Liposuction & Fat Transfer for
Face & Body under Local Anaesthesia
October 7-8, 2019: Seoul, South Korea
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Learn How to Deliver a More Natural and Longer-Lasting Result in Your Patients using Dr. Steve R. Cohen's Exclusive ITR2 Technique at our upcoming Mini-Fellowship happening in San Diego, California, USA!
IFAAS Mini-Fellowship (Observation)
Tissue Replacement and Regeneration & ABC Face Lift
August 15-16, 2019: San Diego, California, USA
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