Is anesthetic typically used when suturing with surgical staples?

July 31, 2007 12:25 PM

Is anesthetic typically used when suturing with surgical staples?

I recently had a head injury that left me with a 3-inch gash on top of my head. At the ER (in small-town Oklahoma), the doctor used 7 surgical staples to close up the wound, however, he did NOT use anesthetic. This hurt like hell, it was more painful than the original injury.

Should he have used anesthetic, or is this a situation where they wait for you to ask for it?

posted by kingtaj to health & fitness (17 comments total)

I once took a friend into the emergency room for a similar injury -- he'd cut his head open and needed 11 staples. The doctor did not use anesthetic. I'm not sure why.
posted by ourobouros at 12:32 PM on July 31, 2007

The doctor told me that the needle giving the anasthetic would hurt more/be more trouble (for both of us) than just putting the staples in and getting it over with. (Of course, he also said I was only getting 6, and then gave me 11, but I digress.)
posted by inigo2 at 12:33 PM on July 31, 2007

It'll depend on the procedure, and what policies may be in effect. Anesthesia requires supervision from someone trained in its use, which is why a specializing physician may oversee the use of gas in an operating room.

Insurance costs and liability also figure into things; if a local, regional, or other type is administered, the doctor performing the operation has to justify the need for using it. Some specialists may omit using it altogether for "minor" procedures, where discomfort can be kept in check (for the most part) with codeine and Tylenol, or over the counter relief.
posted by Smart Dalek at 12:41 PM on July 31, 2007

I don't think it's typical, but my experience with surgical staples is limited to my cat.
posted by tastybrains at 12:50 PM on July 31, 2007

I believe injected local anesthetic is not particularly effective without a good bit of flesh to numb. Scalps are too bony to make them worthwhile, and the process of injecting it is going to end up taking longer and being more painful than the staples or sutures. My understanding is that your experience is fairly typical; if the wound had been in your face or most anywhere else, you probably would have gotten a bit of lidocaine or whatever somewhere around the time of the wound cleaning and before it was closed.

It is also probably easier to keep your head still, even without any pain relief, than just about any other part of your body. You can't twitch your scalp very much.
posted by Lyn Never at 12:57 PM on July 31, 2007

About two years ago, I ran into an armored personnel carrier and got a huge gash on my skull that required 12 staples to close. I got a local anesthetic (I think it was lidocaine). It took several injections, and hurt like HELL. But after, I barely felt the staples - did feel the tugging in some places away from the numbed area, though. But I am a wuss when it comes to pain, and was glad to have it.
Pictures available upon request.
posted by ObscureReferenceMan at 1:15 PM on July 31, 2007

That's pretty fucked up. It's easy to make the injection less painful - buffer the lidocaine, inject very slowly, inject through already anaesthetized tissue, etc. The thing is, injecting the wound is a 'known' pain. The possible number of ways things could go less than perfect trying to tug and align and staple the wound is not. The doc was trotting out a convenient bit of nonsense, to save time. But take it as a compliment that he thought you tough enough to get through it.
posted by docpops at 2:36 PM on July 31, 2007

I don't remember anesthetic being used when they stapled my scalp together for about the same type of wound you have, but the area was already rather desensitized from me holding ice to it while waiting in the ER. They definitely didn't use anesthetic when they removed the staples.
posted by casarkos at 5:41 PM on July 31, 2007

I had a scalp wound requiring six staples at the local urgent care. Local anesthetic was administered, which hurt briefly, but after that, I didn't feel the staples. Nothing was administered when they were taken out. Could have been a combination of pulled hair, scabbing and/or incompetence, but yikes, that hurt.
posted by Otis at 6:18 PM on July 31, 2007

I got my head stapled when I was a kid (slipped in the bathroom, encountered sharp molding near floor) and I think they did something to numb the area. But then, I was 9 years old (and female fwiw) so the doctor might have been kinder to me than you. All I remember is feeling pressure.
posted by MadamM at 6:21 PM on July 31, 2007

Weird. When I had my staples out, I was expecting pain. But it felt like almost nothing.
posted by ObscureReferenceMan at 6:59 PM on July 31, 2007

Clearly, you're not acquainted with one of the lesser-known Patrick Swayze works.
posted by Cool Papa Bell at 7:37 PM on July 31, 2007

I would have told the doctor to eff off... no staples without numbing. For some reason, they always want to try to start an IV on the palm side of my wrist, which hurts like hell, and I won't let them do that anymore without numbing.
posted by IndigoRain at 8:12 PM on July 31, 2007

I had 3 staples in my head about 2 years ago. They did indeed use injected pain-killers. But that part hurt bad enough. About 20 mins later i got the staples. I'm very happy I'd had the injections, as it was a very unpleasant sensation.

Thankfully they were a breeze to remove a few weeks later, although the scabbing up was pretty gross.
posted by efalk at 8:42 PM on July 31, 2007

Another anecdote: when my 2-year-old got a scalp lac, the doctor who put in the staples gave me the same "injections for local anesthesia would hurt more than the staples" argument someone mentioned above. But the doctor who took the staples out the next week seemed a bit appalled they hadn't given the kid a local, and when I explained the previous doctor's rationale, replied, "Apparently she's never had staples herself."

From this, I deduced that there are differences of opinion and practice among doctors, even doctors at the same clinic.
posted by not that girl at 11:36 PM on July 31, 2007

I'll be an ER resident in less than a year and have stapled many a scalp already. Every single time I've used plentiful lidocaine, and all my attendings would be pretty pissed at me if I hadn't. We should always treat pain. It takes seconds to fully anesthetize a scalp, and should be done anyway so you can deeply probe the wound, make sure the cut hasn't gone thru the galea (a layer below the skin and fat), and irrigate the hell out of it to decrease the bacterial count.

That being said, I can't comment on your particular situation, cause I don't know the other issues going on in the ED at the time!
posted by gramcracker at 7:00 PM on August 1, 2007

Just a followup to the original post... this is where it got much worse.

Pulling the staples out was even WORSE than getting them put in! Now it is funny but at the time it was nothing short of horror.

I had to find a local doc to remove the staples and I just picked the first guy who had an opening (after all, how hard could it be??).

This particular doctor was very old, over 70 I would guess. His eyesight was failing, and he could not get two of the staples out. He ended up tugging at them over and over (but couldn't properly see what the holdup was). He even tried using one of those old-fashioned magnifier attachments on his eyeglasses. It was awful. I was ready to surrender my life secrets if only the torture would stop.

The old doc apologized profusely and I felt sorry for him too. After about 10 minutes of failing to get the last 2 staples out, he called in a younger doctor, who was quite annoyed, but promptly pulled the remaining staples out within 30 seconds.

The lessons of the story are do NOT get hit in the head hard enough to produce a gash that requires staples. Do NOT let anyone over 70 remove staples from your head, and always ask for a local anesthetic.
posted by kingtaj at 2:25 PM on May 3, 2008