General Anesthesia Vs. Local Anesthesia in Rhinoplasty

A common concern of patients is which the “best” anesthesia for nose surgery is.

Types of anesthesia

The types of anesthesia that can be used in rhinoplasty are basically 3:

  • Local exclusively
  • Local + deep sedation
  • Local + general anesthesia

Each anesthetic method has its pros and cons.

About local anesthesia

The disadvantages of exclusive local anesthesia are:

  • Pain at the time of anesthetic infiltration
  • Risk of arrhythmias or cardioactive reflexes during infiltration and/or during surgery
  • Pain in some maneuvers (especially in osteotomies)
  • Patient discomfort and intraoperative stress from being awake, listening, and feeling the surgical steps, although there is no pain.
  • Limited time duration, requiring increasing the speed of the procedure, which can lead to leaving unresolved imperfections, compromising the final result.
  • Discomfort for the surgeon

Advantages of exclusive local anesthesia:

  • More economical
  • discharge in one hour (general anesthesia or sedation requires control of at least 3 hours after surgery)

It is false that local anesthesia is without risk. Drugs used in local anesthesia can cause cardiac arrhythmias, as well as stress for the awake patient. We do not recommend the use of exclusive local anesthesia for rhinoplasty procedures, except for a minor touch-up that does not last for more than 30 or 40 minutes.

Local anesthesia with sedation is an alternative to general anesthesia that leaves the patient half asleep but breathing spontaneously through the mouth, generally with oxygen-enriched air.

About general anesthesia

General anesthesia implies that the patient is completely asleep, and control of breathing is the responsibility of the anesthesiologist.

General anesthesia is now used for rhinoplasty surgery in the vast majority of major centers worldwide for several reasons:

  • More peace of mind for the patient and for the surgeon
  • The intervention can be prolonged as long as necessary until the desired changes in the nose are achieved without the "rush" that exists with local anesthesia.
  • The patient's breathing is more assured than with sedation and blood entry into the tracheobronchial tree is prevented. It also prevents the possibility of aspiration of gastric contents.
  • Lower overall risk.

What do we recommend?

In all cases (even with exclusive local anesthesia), it is recommended to perform the procedure in a sanitary operating room and not do it in the office.

Our preference is the use of general anesthesia for the advantages expressed above. Currently, with advances in anesthesiology, it is achieved that the patient is very comfortable in the immediate post-operative period and can withdraw from discharge from the sanatorium in approximately 4 to 6 hours after the intervention in perfect condition.

The use of local anesthesia + deep sedation is an anesthetic alternative that must be used by a well-trained anesthesiologist specialized in this type of technique.