First, some definitions:
- Local anesthesia. Having a procedure done “under local” means that you have an injection to numb the area before surgery. Sometimes this is in the form of a block, where numbing medication is injected around a nerve. Sometimes the numbing medicine is injected directly into the area that is being worked on (e.g. if you’re having a cut sutured up). The key thing to know is that you are awake and aware of what is happening. Local anesthetic works very well, but the injection itself is painful (although thankfully brief). Local also does not work well for very large surface areas.
- General anesthesia. This is the other end of the spectrum: you are completely asleep for the procedure, and you may have a tube down your throat (i.e. you are intubated) to help you breathe.
- Sedation. This is somewhere between local and general anesthesia. You receive some medications to make you sleepy so you don’t really know what is going on, but you’re not all the way to sleep. This is the “twilight” anesthesia that is used for colonoscopies.
Generally what type of anesthesia you need is dictated by the procedure that is being performed. An abdominoplasty or breast reduction, for example, is virtually always done under general anesthesia. Those operations last several hours and cover a large surface area, so general anesthesia is the best way to keep the patient comfortable. A face lift, on the other hand, can be done under local with some sedation. But many surgeons will also perform face lifts under general anesthesia. A face lift lasts over three hours, and I find I can keep my patients more comfortable if they are fully asleep. Something like a blepharoplasty (eye lift) can go either way. If I am operating on only the upper eyelids, I find that I can keep the patient very comfortable with just local anesthesia. However if a patient is nervous about the procedure, or cannot tolerate things near their eyes, then sedation certainly helps.
Do you have a question about types of anesthesia?