Expert: Ronald Levy, M.D. - 8/28/2010

Question
I've a history of resistance to topical anesthesia and require about 3xs the usual amount of lidocain internally for supposed “simple” procedures. Taking valium or halcyon prior has minimal positive effect (makes drive to clinic/hospital comfortable but that’s all). I'm graphically honest with staff when planning for new procedures. Nowadays, most techs/nurses listen to my experiences and seem to “get it” but doctors… no offense but what am I not saying or doing that I continue to be met with resistance to adjusting protocol to fit my needs? Recent wire loc prior to lumpectomy a traumatic experience: screaming, fainting, wheelchair needed, extra staff to keep me from ruining wire placement as I fainted. The plan discussed:freeze spray instead of topical lidocain (was not enough to be effective), extra lidocain injected into the breast with “extra” wait time between each (not followed). I had to defend myself as I lay crying “You are NOT ME. You can’t compare what you think you'd feel to what I feel”. I’m polite & diplomatic but trying to address my needs I've had little luck talking to one doctor (surgeon for example)about bad experiences with other doctors. What more can I do? I’ve exhausted my skills. I’m told/understand many of these procedures aren’t an option for a general—at least that’s what I was told for the pre-op wire location & the breast core-biopsies nightmare from last year.

Answer
The most common problem with local is that they don't wait long enough for it to take effect (can take up to 15 minutes) or they don't know how to inject it correctly to cover the area in need. I doubt that you are resistant to locals but rather have just had bad experiences. I can't really tell you how to improve that other than to request an anesthesiologist be present to heavily sedate you for the procedure.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston