Sedation and Local Anaesthetic for Cosmetic Surgery

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Local anaesthetic and sedation is now a well-established method for providing safe and stable conditions for many forms of surgery. The technique requires close co-operation between the surgeon and the anaesthetist and involves the infiltration of a local anaesthesia into the operative field or around the nerves supplying the area in conjunction with sedative and powerful painkilling drugs. This allows pain-free surgery, patient comfort, safety and rapid recovery.

The level of sedation can be adjusted according to the needs of the patient. This is made possible by intravenous infusion of highly controlled amounts of painkilling and sedative drugs via infusion pumps. These pumps allow very accurate administration of the required drugs to achieve the right conditions for surgery. The drugs we use at The Westbourne Centre (Birmingham, UK) are a combination of Remifentanil (a strong very short-acting opiate) and Propofol. This drug is a powerful sedative and is also short-acting. The combination of local anaesthetic and sedation therefore enable us to carry out a remarkable range of cosmetic surgery, such as facelifts, breast reductions, breast augmentations, abdominoplasty, and liposuction without a general anaesthetic.

Compared to general anaesthetic techniques, the rate of recovery immediately after surgery is faster. During surgery, patients breathe on their own and therefore do not require an‘artificial airway’. The local anaesthetic administration also means that the post-operative pain is better controlled and the need for very strong post-operative opiate drugs is often unnecessary.

Because the drugs are so short acting (short half-life), patients recover from the sedation very quickly. Therefore, compared to general anaesthetic techniques, the recovery and transition from sedation to fully awake is faster and usually more predictable. As patients are not intubated (artificial airway), there is virtually no incidence of post-operative coughing, which could compromise the results of the surgery or cause post-operative bleeds. Moreover, as relatively small amounts of sedatives and painkillers are given, this also reduces the risk of post-operative nausea & vomiting, thus further decreasing the potential of post-operative complications. This allows early discharge from hospital. As a result, surgery, that had previously required an overnight stay because of the effects of general anaesthesia, can now be carried out as day cases.

My own personal audit over the last 5 years has revealed that this is a very safe technique with high patient satisfaction. During the procedure, the patient is very carefully monitored, as during any operation. The technique requires skilled and highly trained anaesthetists. Surgical technique has never been compromised and because the surgery also relies on the efficacy of the local anaesthetic infiltration carried out by the surgeon, I have found that it requires more operative precision and care. I believe this enhances the overall outcome and results of surgery.

As with all operations and techniques, patient selection is very important. Local anaesthetic and sedation would not be used for surgery where it would be difficult to provide adequate local anaesthesia, such as intra-abdominal or transcranial surgery. Spinal anaesthetic techniques (although very effective) are not really suitable for day case surgery, as the recovery of function can be variable and overnight stays may be required.

We have found the vast majority of patients find the process of sedation a pleasant experience and do not recall anything about the operation, unless they have requested that their level of sedation is minimal. Some patients feel they want to be more in control of their feelings during surgery. With these patients our technique is to increase the level of sedation only during the administration of the local anaesthetic and then to titrate the amount given for the rest of the operation, so that patients can remain awake but pain free if they so wish.
In summary, local anaesthetic and sedation is a technique, which is safe and effective. It has changed the way cosmetic surgery can be carried out. It allows rapid recovery and good post-operative pain relief, with no compromise in the quality of the surgery carried out. The delivery of this technique, however, requires experience and skill and very close co-operation between surgeon and anaesthetist. Patient satisfaction has been high.

  1. Consultant Plastic, Reconstructive and Aesthetic Surgeon Hiroshi Nishikawa performs cosmetic surgery procedures using local anaesthetic and sedation at The Westbourne Centre in Birmingham, UK.

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Birmingham Plastic Surgeon