Techniques to reduce pain associated with hair transplantation: optimizing anesthesia and analgesia

The importance of pain control in hair transplantation cannot be overemphasized. Adequate preoperative sedation to reduce anxiety, raise pain threshold, and induce amnesia is fundamental to minimizing operative pain. Most of the pain associated with the procedure results from injection of the local anesthetic. Once initial anesthesia is achieved, proper maintenance of anesthesia is of paramount importance especially with the trend toward larger numbers of grafts being performed in one session with prolonged operative times. The choice of local anesthetic agents, infiltration technique, optimal field blocks and nerve blocks, proper hemostasis, timely repetition of anesthesia, and use of analgesics intraoperatively, with the goal of maintaining the patient pain-free during the procedure, are fundamental. In addition, reduced pain on infiltration can be achieved with buffering and warming of the local anesthetic solution as well as techniques to decrease sensation or partially anesthetize the skin prior to injection. Techniques such as bupivacaine donor area field block in the immediate postoperative period and early administration of analgesics can greatly influence postoperative pain. Along with excellent cosmetic results attainable with modern techniques, improving patients' experiences during the surgical process will enhance the public perception of hair transplantation and will encourage prospective patients to seek this treatment modality.