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Could anesthesia contribute to post-op pain?
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Could anesthesia contribute to post-op pain?

Posted Wednesday, January 06, 2010

All surgery patients are warned to expect some pain after their operation, and no one is expected to undergo their selected procedure without anesthesia. However, it may be the anesthesia itself that makes post-surgery pain worse than it would otherwise be.

It is already known in the medical community that some anesthesia drugs can cause pain in the lungs or at the injection site, which anesthesiologists counteract with preemptive drugs; and it was widely believed that the pain was temporary. However, according to a Georgetown University Medical Center study, the noxious chemicals in general anesthesia can activate the nerves the recognize pain and trigger inflammation, creating an effect that lasts long after the surgery itself.

Specifically, the kind of nerve that becomes sensitized by the chemicals is called TRPA1, or the "mustard oil receptor," which causes burning pain. The researchers found that mice genetically engineered to the lack TRPA1 nerve cells showed no anesthesia-prompted pain.

A possible solution would be an anesthesiologist's choice to use sevoflurane, an anesthesia drug devoid of the noxious chemicals in question. The researchers hope that further testing on humans will make this and other options a priority.

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Dr. Richard A. Baxter | Plastic Surgeon
This is a very provocative piece, and raises several issues. For one, most general anesthesia today is done with sevo, at least in my practice, so the issue is more of a historical (and hysterical) one. Second, even when general anesthesia is used (as opposed to intravenous sedation + local), I use local anesthesia to block the post op pain so the patient doesn't wake up in discomfort. What makes it provocative is the ongoing debate about the risks of general anesthesia vs. tumescent technique for lipo, an issue surrounded by misinformation. Both techniques have risk but are generally safe when done properly, and framing the debate in terms of only 2 alternatives ignores the option of sedation plus tumescent. Knowing anesthesia options is important to making good decisions about surgery of any type.

Posted January 12, 2010 2:43 PM

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Dr. Richard A. Baxter
Plastic Surgeon
An art major in college at UCLA, Dr. Richard A. Baxter combines his creative talents with his scientific, medical aptitude to provide refined aesthetic results for his patients. Certified in plastic surgery and in practice for almost two full decades and as a member of the International Society of Aesthetic Plastic Surgery, he is always seeking to evolve his techniques and expand his available procedures. He participates in numerous clinical trials and is driven by the challenge of alternative techniques, which allow for more advanced methods and individual creativity. As a surgeon, artist, researcher, presenter and lecturer—and having performed several thousand breast augmentation surgeries throughout his career—Dr. Baxter believes a multiplicity of corresponding talents helps make for more inclusive, guided care.

Visit Dr. Baxter's NewBeauty profile.

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