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To the Editor I congratulate Dr Hom on his recent article titled “Enhancing the Art of Care During Awake Procedures.”1 All of the points he makes are excellent. I hope the article is widely read because it contains many adjunctive keys to successful ambulatory surgery.
I have been using local anesthesia for most of my cases (all outpatient) for more than 4 decades. My hand was forced initially, when as a Navy surgeon during the Vietnam Conflict, I was faced with a heavy surgery schedule but a shortage of anesthesiologists. I went to the library to learn what I needed about Eastern medicine. I then called a meeting with my corpsman to say we were going to do most of our cases under local anesthesia. With the addition of acupressure, “TLC,” and an environment of calm and reassurance I found I could do almost any facial procedure under local anesthesia (even, at the time, blast injury tympanoplasties). The concept of local anesthesia surgery during my military experience was so successful that I brought it into my private practice when I left active duty. I perform over 90% of my procedures (rhinoplasty, blepharoplasty, face-lift, brow-lift) with the patient under local anesthesia. Today, I have the privilege of working with several excellent anesthesiologists who provide minimal intravenous analgesia to compliment my local anesthesia. The acupressure remains an important part of the local anesthesia injection, mitigating most of the discomfort. The preoperative and operative intravenous medication protocol (Demerol, Phenergan, Versed) that I use for my patients is a formula that has remained the same over the years because of its effectiveness, reliability, safety, and antiemetic properties. I recall no patient having had a regrettable experience with this protocol.
Pastorek N. The Art of Local Anesthesia Surgery. JAMA Facial Plast Surg. 2015;17(3):226-227. doi:10.1001/jamafacial.2015.0195