Practice Pearl: A Novel Anesthetic Solution for Decreasing the Blood Loss at the Recipient Site of Hair Transplantation (Namazi Solution)

Abstract

The tumescent anesthetic technique offers both anesthesia and vasoconstriction. A solution of 0.1% lidocaine, 1:1000,000 epinephrine, and 10 mEq/l of sodium bicarbonate is injected into the subcutaneous tissue until it becomes quite firm. A dual level of tumescent anesthetic infiltration expedites hair grafting or strip harvesting for hair transplantation, facilitates the placement of the correct incisional angle of instruments inserted into the donor site, reduces bleeding, and increases the exit angle of the hairs, thereby promoting increased survivorship of hair shafts and bulbs [2, 3]. However, despite the use of this technique, bleeding from the recipient sites frequently occurs, which makes transplantation of the harvested follicles difficult. Tranexamic acid is a synthetic derivative of the amino acid lysine that exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Tranexamic acid is useful in a wide range of hemorrhagic conditions. The drug reduces postoperative blood loss in a number of surgery types such as cardiac surgery with cardiopulmonary bypass, orthotopic liver transplantation, and transurethral prostatic surgery. Tranexamic acid decreases the blood loss from upper gastrointestinal bleeding, menorrhagia, placental bleeding, traumatic hyphema, postpartum hemorrhage, and conisation of the cervix. Tranexamic acid significantly reduced mean blood loss after oral surgery for patients with hemophilia and was effective as a mouthwash for dental patients receiving oral anticoagulants. Systemically administered tranexamic acid is well tolerated. Nausea and diarrhea are the most common adverse events. Increased risk of thrombosis with the drug has not been demonstrated in clinical trials [1]. The antifibrinolytic property of tranexamic acid could be elegantly used for the reduction of bleeding at hair transplantation recipient sites. The addition of one 500-mg (5 ml) ampule of tranexamic acid to the tumescent anesthetic solution can significantly speed and ease the transplantation of the harvested follicles into the recipient sites while decreasing the stress of the operation.