Local anesthesia is a versatile and essential tool in modern medical practice, enabling a wide range of procedures to be performed with minimal discomfort to the patient. It is essential to any anesthesiologist’s toolkit; however, non-anesthesiologist physicians in various specialties also frequently utilize local anesthesia to provide pain management.
Local anesthesia involves the administration of anesthetic agents to a specific area of the body, resulting in the temporary loss of sensation without affecting consciousness. This technique is widely used by non-anesthesiologist physicians across multiple fields, including dermatology, orthopedic surgery, obstetrics and gynecology, and emergency medicine.
Dermatologists use local anesthesia for procedures such as excisional biopsies, removal of skin lesions, and cosmetic interventions like botox injections and fillers. Agents like lidocaine and bupivacaine are commonly used to numb the procedure area, allowing for painless and precise interventions 1. General practitioners and surgeons often perform minor surgical procedures under local anesthesia, including laceration repairs, mole removals, and the drainage of abscesses, for which local anesthesia provides adequate pain relief, enabling these procedures to be performed safely in outpatient settings 2,3. Orthopedic surgeons and sports medicine physicians use local anesthesia for joint injections, fracture reductions, and minor surgical repairs, for which techniques such as peripheral nerve blocks provide targeted pain relief, improving procedural outcomes and patient satisfaction 4–6. In obstetrics and gynecology, local anesthesia is used for episiotomies, cervical cerclage, and minor gynecological surgeries, as well as for pain relief during labor and delivery in the form of pudendal nerve blocks 7–9. Emergency physicians use local anesthesia for rapid pain relief in acute settings, including for treating wounds, performing nerve blocks for fractures, and managing dislocations 10,11. In addition, ophthalmologists use local anesthesia for various eye procedures, including cataract surgery, glaucoma treatments, and retinal surgeries—topical and injectable anesthetics ensure the patient’s comfort while preserving vision and eye function 12.
Local anesthesia is also a cornerstone in dental practice, used extensively for tooth extractions, fillings, root canal treatments, and periodontal surgeries. Dentists can administer agents like lidocaine and articaine to ensure patient comfort during these procedures 13.
The use of local anesthesia by non-anesthesiologist physicians offers several benefits. First, it enhances patient comfort: local anesthesia effectively manages pain during procedures, improving the patient experience and reducing anxiety. Second, with local anesthesia, certain procedures can be carried out in office or outpatient settings, reducing the need for hospital admissions and general anesthesia. Third, local anesthesia minimizes systemic risks associated with general anesthesia, making it suitable for patients with comorbidities or those undergoing minor procedures. Finally, by avoiding the need for anesthesiologist services and operating room time, local anesthesia can reduce healthcare costs 14–16.
While local anesthesia is generally safe, non-anesthesiologist physicians must adhere to best practices to ensure optimal outcomes. Physicians must receive adequate training in the administration of local anesthesia, including knowledge of pharmacology, techniques, and potential complications. A thorough patient history and assessment are also essential to identify any contraindications or allergies to anesthetic agents, and patients should be informed about the procedure, the anesthesia used, and potential risks and benefits, ensuring informed consent is obtained. Physicians should then monitor patients during and after the procedure and be prepared to manage any adverse reactions or complications, such as allergic reactions or toxicity 17–19.
References
1. Rękas-Dudziak, A., Męcińska-Jundziłł, K., Walkowiak, K. & Witmanowski, H. The use of local anaesthetics in dermatology, aesthetic medicine and plastic surgery: review of the literature. Postepy Dermatologii i Alergologii (2023). doi:10.5114/ada.2023.125221
2. Williams, D. C. The use of local anaesthesia in general practice. https://doi.org/10.1177/1755738015578491 8, 395–403 (2015).
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5. Different Types of Anesthesia During Orthopedic Surgery – Raleigh Orthopaedic Surgery Center. Available at: https://www.raleighsurgerycenter.com/surgery-center-nc/different-types-of-anesthesia/.
6. Orthopedic Anesthesia Division. Available at: https://www.massgeneral.org/anesthesia/clinical-services-and-programs/surgical-anesthesia/orthopedic-anesthesia.
7. Toledano, R. D., Kodali, B.-S. & Camann, W. R. Anesthesia Drugs in the Obstetric and Gynecologic Practice. Rev. Obstet. Gynecol. 2, 93 (2009).
8. Neis, F., Wallwiener, D., Henes, M., Krämer, B. & Brucker, S. Opinion paper: gynecological surgery in local anesthesia? Arch. Gynecol. Obstet. 306, 1063–1068 (2022).
9. Local Anesthetics | Obstetric Anesthesia Practice | Oxford Academic. Available at: https://academic.oup.com/book/30622/chapter-abstract/258963675?redirectedFrom=fulltext.
10. Norris, R. L. Local Anesthetics. Emerg. Med. Clin. 10, 707–718 (1992).
11. Crystal, C. S. & Blankenship, R. B. Local anesthetics and peripheral nerve blocks in the emergency department. Emerg. Med. Clin. North Am. 23, 477–502 (2005). DOI: 10.1016/j.emc.2004.12.012
12. Mahan, M., Flor, R. & Purt, B. Local and Regional Anesthesia in Ophthalmology and Ocular Trauma. StatPearls (2023).
13. Mathison, M. & Pepper, T. Local Anesthesia Techniques in Dentistry and Oral Surgery. StatPearls (2023).
14. Local Anesthesia: Types, Benefits, and Side Effects. Available at: https://www.webmd.com/a-to-z-guides/what-to-know-about-local-anesthesia.
15. Local anesthesia: Uses, types, side effects, and safety. Available at: https://www.medicalnewstoday.com/articles/265689. (Accessed: 7th August 2024)
16. Local anaesthesia – NHS. Available at: https://www.nhs.uk/conditions/local-anaesthesia/.
17. Becker, D. E. & Reed, K. L. Local anesthetics: review of pharmacological considerations. Anesthesia progress (2012). doi:10.2344/0003-3006-59.2.90
18. Reed, K. L., Malamed, S. F. & Fonner, A. M. Local Anesthesia Part 2: Technical Considerations. Anesth. Prog. 59, 127 (2012). doi: 10.2344/0003-3006-59.3.127
19. Klein, A. A. et al. Recommendations for standards of monitoring during anaesthesia and recovery 2021. Anaesthesia 76, 1212–1223 (2021).doi: 10.1111/anae.15501