Awake but Comfortable: What Local Anaesthetic Actually Feels Like

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For many people, the idea of being awake during a procedure is more worrying than the procedure itself. Whether it is a tooth extraction, a mole removal, a minor operation or a cosmetic treatment such as a hair transplant, the same questions come up. Will I feel it? What will I be aware of? What if the numbness wears off halfway through?

Local anaesthetic is one of the most widely used tools in medicine and dentistry, and understanding how it works can take much of the fear out of the experience. This article explains what local anaesthetic is, what you are likely to feel, and some practical ways to make the experience more comfortable.

What a local anaesthetic is

A local anaesthetic numbs a specific area of the body while you stay awake. The NHS explains that it may be used when it is safe for you to be awake during a procedure and when it is possible to numb the area being treated, and that it works by stopping nerves from sending pain signals to the brain.

This is different from a general anaesthetic, which makes you unconscious. For many minor procedures, local anaesthetic is preferred because recovery is quicker and it avoids the risks and after-effects that come with being put to sleep.

Local anaesthetic can be given in several ways, including as a cream, gel, spray or injection. DermNet's overview of local anaesthesia explains the different types and how they are used in skin, dental and surgical procedures. Lidocaine, also known as lignocaine, is one of the most commonly used.

What you will feel

The injection

For most procedures involving the skin or scalp, the anaesthetic is given by injection. This is usually the only part that people describe as painful, and the discomfort tends to be brief. Many people describe a sharp scratch followed by a stinging or burning sensation as the liquid goes in, which fades as the area becomes numb.

Becoming numb

The NHS notes that you will usually have a warm, tingling feeling as the anaesthetic starts to work, and that the area should then feel totally numb. The person treating you will check that the area is numb before they start.

During the procedure

Being numb does not mean feeling nothing at all. Local anaesthetic blocks pain, but you may still be aware of:

• Pressure or pushing
• Movement or tugging
• Sounds, such as instruments or equipment
• Temperature, such as cool liquids

These sensations can feel strange at first, but they are not painful. It can help to know in advance that they are normal and expected.

If you feel pain

If you feel sharp pain at any point, say so straight away. The NHS explains that the clinician will make sure you have the right amount of anaesthetic and will monitor you during your treatment. Topping up the anaesthetic during a longer procedure is routine, and nobody expects you to put up with pain quietly.

How long it lasts

How long the numbness lasts depends on the type and dose of anaesthetic used, and on whether it is combined with adrenaline, which narrows the blood vessels and helps it last longer. For longer procedures, the clinician may use a longer-acting anaesthetic or give further doses as needed.

As the anaesthetic wears off afterwards, the NHS notes you may feel tingling or a burning sensation and some soreness where the injection was given. These effects usually settle within a few minutes or hours. Ask your clinician in advance what pain relief is recommended once the numbness wears off.

Is it safe?

The NHS describes local anaesthetics as generally safe, with serious side effects being very rare. Possible minor side effects include soreness at the injection site, dizziness, headaches, blurred vision and twitching muscles, which usually pass quickly.

Before your procedure, make sure the clinician knows about:

• Any previous reactions to anaesthetics, including at the dentist
• Any medicines you take, especially blood thinners
• Any heart, liver or bleeding problems
• Whether you are pregnant or breastfeeding

What it is like in practice: the example of a hair transplant

Hair transplants are a good example of a longer procedure carried out under local anaesthetic. Patients are awake throughout, often for several hours, and the scalp is numbed with injections at the start, with top-ups as the procedure continues. Most people find that once the initial injections are done, the rest of the procedure is comfortable enough to watch films, listen to music or even doze. If you are curious about this specific example, the guide Do hair transplants hurt? from My Hair UK walks through what patients typically feel during and after the procedure.

Tips for a more comfortable experience

Before the procedure

• Ask questions in advance. Knowing exactly what will happen, step by step, reduces anxiety for most people.
• Eat normally unless told otherwise. With local anaesthetic, you usually do not need to fast, but always check the instructions you are given.
• Avoid caffeine if you are prone to feeling jittery, as it can make anxiety worse.
• Wear comfortable clothing and bring something to help pass the time if the procedure is long.

During the procedure

• Breathe slowly. Slow, steady breathing can help you relax and may reduce the sting of the injection.
• Use distraction. Music, a podcast or conversation can help, as can focusing on a fixed point.
• Agree a signal. If you are worried about speaking up, agree a hand signal with your clinician to let them know you need a pause.
• Tell them how you feel. If you are anxious, saying so allows the team to go more slowly and explain what they are doing.

If you have a fear of needles

A fear of needles is very common, and you are unlikely to be the first person your clinician has treated who feels this way. Let them know in advance. Numbing creams can sometimes be applied before the injection, and simple techniques such as distraction or lying down can help. If your fear is severe enough to stop you having treatment you need, the NHS page on phobias explains the support available, including talking therapies.

The bottom line

Local anaesthetic allows a huge range of procedures to be carried out safely while you stay awake. For most people, the injection is the only uncomfortable part, and after that the main sensations are pressure and movement rather than pain. Knowing what to expect, asking questions and speaking up if anything hurts can make the whole experience far less daunting than it might first seem.

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