Injecting Local Anesthesia in a Minimally Painful Fashion

40S The last decade has witnessed major improvements in local anesthetic injection and application techniques, which have permitted surgeons to do more and more under pure local anesthesia with minimal pain during the injection of the local agents. This has led to increase in patient safety and convenience while maintaining total patient perioperative comfort. Many procedures in hand surgery,1 cosmetic surgery,2 facial skin cancer reconstruction,3 and other procedures such as adult cleft lip repair4 can now be performed with the wide awake approach without sedation. For the patient, many of these procedures have been reduced to the simplicity of an office dental procedure. In addition, postoperative pain control with new developments in local anesthesia have also improved the patient experience. This article will review 2 exciting new areas of minimal pain local anesthetic injection techniques, new medications, and the best evidence to support the changing landscape of local anesthesia in plastic surgery.