Nusbaum Bernard P
Hair Transplant Institute of Miami, Miami, Florida 33156, USA.
Am J Clin Dermatol. 2004;5(1):9-15. doi: 10.2165/00128071-200405010-00003.
The importance of pain control in hair transplantation cannot be overemphasized. Adequate preoperative sedation to reduce anxiety, raise pain threshold, and induce amnesia is fundamental to minimizing operative pain. Most of the pain associated with the procedure results from injection of the local anesthetic. Once initial anesthesia is achieved, proper maintenance of anesthesia is of paramount importance especially with the trend toward larger numbers of grafts being performed in one session with prolonged operative times. The choice of local anesthetic agents, infiltration technique, optimal field blocks and nerve blocks, proper hemostasis, timely repetition of anesthesia, and use of analgesics intraoperatively, with the goal of maintaining the patient pain-free during the procedure, are fundamental. In addition, reduced pain on infiltration can be achieved with buffering and warming of the local anesthetic solution as well as techniques to decrease sensation or partially anesthetize the skin prior to injection. Techniques such as bupivacaine donor area field block in the immediate postoperative period and early administration of analgesics can greatly influence postoperative pain. Along with excellent cosmetic results attainable with modern techniques, improving patients' experiences during the surgical process will enhance the public perception of hair transplantation and will encourage prospective patients to seek this treatment modality.
疼痛控制在毛发移植中的重要性再怎么强调也不为过。充分的术前镇静以减轻焦虑、提高痛阈并诱导遗忘，是将手术疼痛降至最低的根本。与该手术相关的大部分疼痛源于局部麻醉剂的注射。一旦实现初始麻醉，麻醉的妥善维持至关重要，尤其是在单次手术中移植毛囊数量增多且手术时间延长的趋势下。局部麻醉剂的选择、浸润技术、最佳区域阻滞和神经阻滞、适当的止血、及时重复麻醉以及术中使用镇痛药，目标是使患者在手术过程中无疼痛，这些都是根本。此外，通过对局部麻醉溶液进行缓冲和加温以及在注射前采用减少感觉或使皮肤部分麻醉的技术，可以减轻浸润时的疼痛。诸如术后即刻布比卡因供体区域阻滞以及早期给予镇痛药等技术，可极大地影响术后疼痛。随着现代技术可实现出色的美容效果，改善患者在手术过程中的体验将提升公众对毛发移植的认知，并鼓励潜在患者寻求这种治疗方式。
