Expert: Ronald Levy, M.D. - 7/15/2010

Question
Hello Doctor,

This started at the dentist office... from the time I was young, I have had pain during all dental procedures - even with what the dentists considered sufficent numbing. After finding a 'pain free' specialist, he reccomended that I be numbed through the roof of my mouth as well... and through this, I am able to feel very little pain during procedures.

Today, while moving furniture, I succeded in ripping my toe nail almost all the way off. At the ER, the doctor numbed me on the inside of my toe, then the outside, then the bottom - and after still feeling as he tried to pull on the remaining nail to get it off, he injected at the base of the nail. Even at that, it hurt! He felt awful - and we went with the "quick tug like a band-aid" He said I was the first person he hasn't been able to completely numb. I felt somewhat numb - like deep in the toe, but my skin still felt very sensitive.

This reminded me of when I had my son ten years ago, and the epidural wore off incredibly fast and I felt everything as I delivered...

Could all of these things be connected? Can people be resistant to lidocaine & other numbing substances? I am only 28... and my fear is that something worse than a toe nail may happen some day in the future, and what could I possibly tell the doctors to convey that I can't seem to get numb? (btw.. I have been under general anesthesia for wisdom teeth removal, and that went well)

Thank you for your time.

Tisha

Answer
I have never heard of anyone who is truly resistant to local anesthetics. Some areas of the body are notoriously hard to anesthetize, the mouth being a good example. I know this from personal experience having had several root canals where they gave me enough local to numb half my face, yet the tooth was still sensitive. The fingers and toes can also be hard sometimes to numb. I wouldn't worry about it but definitely tell any future anesthesiologist that you've had trouble getting numb.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston