General Versus Local Anesthesia?

At Atlantic Coast Aesthetics, we get a lot of questions about what kind of anesthesia is best and most appropriate for a given procedure or set of procedures. This week’s ACA Question of the Week interested Dr. Thomas Pane, our founder and Chief Medical Officer, largely because of the scale of the procedures to be done. This question came in from our Facebook audience, and asks, “I’m having a tummy tuck, liposuction and a Brazilian butt lift. Is it better to have these under local or general anesthesia?”

Dr. Pane says that the first thing to keep in mind is that in Florida, there is a limit to how much liposuction can be done in a single session due to state law. There is also a legal limit to how long a patient can be kept under general anesthesia outside of a hospital or surgical center, which he discussed in greater detail in a recent Question of the Week session. Any surgeon operating in the state of Florida is bound by these guidelines and restrictions, which means that the locations and times at which certain procedures can be done is limited.

The difference between the types of anesthesia and their effects is the first consideration. A local anesthetic usually involves a mild sedative and anesthetic delivered either intravenously or in pill form. This allow the patient to be awake and aware, but dulls the inevitable pain down to a tolerable level. Spinal anesthesia, where the anesthetic is delivered directly into the spinal column and blocks pain but leaves the patient conscious, is an alternative in situations where the patient cannot be fully unconscious for medical reasons but is unlikely to be able to tolerate the relative pain level inherent in the procedure under local anesthesia. Finally, general anesthesia, delivered in gas or IV form, renders the patient completely unconscious and ensures the patient is unlikely to register any pain during the procedure.

More to the point, Dr. Pane observes that these procedures are very seldom done all at once, largely because it is generally easier to recover from a number of smaller surgeries than trying to do all of them as one “mega-surgery.” Unless there is a very pressing physical reason to do all of the procedures in a single session, most surgeons prefer not to put the patient through unnecessary trauma or the prolonged healing that such an undertaking would require. It is much more common to do the lipo and Brazilian butt lift as a single session and the tummy tuck as a single session.

If the procedures were to be done as a combination, local anesthesia would not be the preferred option. While a Brazilian butt lift and liposuction can and often are done under local anesthesia, a tummy tuck is more problematic because part of the procedure is for the surgeon to artificially tighten the muscles of the abdominal wall, which requires the patient to be more relaxed than local anesthesia allows for. Therefore, if all of these procedures occur in a single session, general anesthesia which renders the patient unconscious would be by far the preferred option, with spinal anesthesia where the patient is awake but unable to experience pain a distant second and local anesthesia barely in the running.

Dr. Pane stresses that anesthesia, whether administered by an anesthesiologist or a CRNA, is very safe and enjoys the lowest risk profile of most any medical procedure. Anesthesia awareness, or the ability to see, hear and otherwise process sensory input during the procedure, is extremely rare, with the American Association of Nurse Anesthesiologists putting the odds at about one in one thousand. However, for maximum safety and minimum risk, it is very important that the surgical and anesthetic team know exactly what medications the patient is taking and why. This reduces the odds of complications arising from drug interactions during the procedures.

An informed, educated patient is far likely to come through the procedures they undergo more safely, quickly and with better results. Because of this, Dr. Pane and ACA say that the only bad question is the one you don’t ask! We encourage you to call us at (561) 422-4116, follow our Facebook page or contact us through our website at https://acplasticsurg.com. We are happy to answer any cosmetic surgery questions you may have, so you can find the right solution to gain the body you’ve always dreamed of. Even better, your question may be ACA’s next Question of the Week, answered live by Dr. Pane himself, helping others who share your concerns and questions!