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Local Anaethsthic For Biopsy


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I received a letter yesterday to confirm I have to more investigations on tuesday after having a routine Mammogramm. I rang to tell them I have POTS, of course the nurse had never heard of it! After readaing my notes she said I may need a biopsy and to take any information I have with me. After looking online I could only find information on POTS and general anaethestic not on local,does anyone have a link that would give me any info that I could take with me? Am I right in thinking it is to do with addrenalin and epi or maybe local is not a problem with POTS?

I have not had local anaesthetic for about 6 years but at the dentistic I always need at least 2 injections before it numbs me.

Thanking you in advance

Hoping you all having better days

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As long as you are medicated the epi has a very short action locally imo. If you are concerned you can simply tell them you have POTS and request no epi in the local. The epi is used to help 1) prolong the action of the drug 2) decrease bleeding at the sight due to vasoconstriction. It can be done without it but you may have to have more than one injection to provide adequate anesthesia. Good luck! Brw most places say that general anesthesia is contraindicated by POTS. As long as you anesthesia provider is educated on POTS I feel it can be done safely. Some aren't because it is not focused on it school. It helps to say autonomic dysfunction... Which is taught.

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Technically, for a biopsy (assuming it is a standard small fiber nerve biopsy), the injection is superficial (localized to the skin) and shouldn't go into the bloodstream. And for SFN biopsies, it's typically a one-injection deal. So, your chances of having any of the epi actually affect you are probably extremely rare.

That said, many POTS patients react horribly to anesthetics with epinephrine even in miniscule amounts. When I had my catecholamine levels tested, my epinephrine levels (adrenaline) were three times the upper limit of normal at rest, so even teeny tiny bits of epi that make it into my system cause severe reactions - hypertensive crises, severe tachycardia, adrenergic storms. I even react to topical agents that contain epi, which is almost unheard of.

So, when I had my small fiber nerve biopsy done, they used anesthetic without epi. Because they only take about a 3mm patch of skin (punch biopsy), I still only needed one injection and didn't feel anything. They said the only reason for epi in this particular case was vasoconstriction to stop the bleeding a little quicker; because it's so superficial, the presence of epi in the injection really doesn't make a huge difference as far as how numb you get (although ordinarily it does). And to be honest, I didn't bleed much. My spouse, who actually did have epi, bled more than I did, lol.

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