Pain Management in PCI: Analgesia and Anesthesia

Abstract

The advances in dermatology in the surgical field, both aesthetic and reparative, have brought to these professionals, used to outpatient care, an apparent problem: How to offer patients the painful treatments in the office and adapt to their expectations of not feeling pain? In addition, an extra problem is: How to offer analgesia to these individuals in accordance with the strict rules that regulate these procedures, especially in the ambulatory setting? The objective of this chapter is to review the use of local anesthetics for aesthetic and reparative dermatological surgical procedures, with special attention to the two most commonly used types for ambulatory procedures: topical local anesthesia and infiltrative local anesthesia. There is an important practical implication in knowing which group a local anesthetic belongs to. The amino esters are metabolized in the plasma by nonspecific esterases and the aminoamides in the liver. Amino esters have greater potential for triggering allergic reactions, as their degradation produces para-aminobenzoic acid (PABA). Thus, knowing which group an anesthetic belongs to makes it possible to indicate, contraindicate, and predict possible adverse reactions to the anesthetic chosen. Local anesthetics block the electrically excitable sodium channels in the tissues and, by doing so in the peripheral nerves, prevent the conduction of painful stimuli from the periphery to the central nervous system (Alster T. Pain Ther. 2:11–9, 2013; Barash PG et al. Clinical anesthesia. LWW; 2017; Cangiani LM et al. Sociedade Brasileira de Anestesiologia. 2013).