About Video

This video illustrates anesthesia and tumesce. Anesthesia objective: (i) protect neurovascular structures, (ii) provide adequate analgesia, (iii) provide adequate hemostasis, (iv) preserve neuroprotective reflexes. To achieve adequate anesthesia the basic techniques required include nerve blocks, ring blocks, and field infiltration. Nerve blocks are performed by delivering a small volume of local anesthetic to a sensory nerve root, which blocks sensation to the entire area supplied by that nerve. The most useful in hair restoration are supraorbital nerve blocks for anesthesia of the frontal hairline area. Nerve blocks only in situations where complete anesthesia has not been achieved in the central hairline after the initial ring block, tumescent infiltration, and secondary ring block with bupivacaine. Nerve blocks useful if anesthesia in the central hairline area begins to diminish during the case despite repeating the bupivacaine ring block. Ring or field blocks are performed by infiltration of a continuous line of local anesthetic in the subcutaneous plane around the inferior border of the area of scalp which will be operated on. This step is then followed by infiltration of the entire zone of the scalp with tumescent local anesthetic in the same plane to complete the block and provide hemostasis. The ring block is reinforced by repeating it with bupivacaine solution after 10–30 minutes, 1–2 hours prior to the end of the case and when needed intraoperatively.