Anaesthetising an Abscess

Ask any seasoned anaesthetist what they would consider to be the 'bread and butter' cases for a junior anaesthetist on call are and they'll probably list the following:

• Appendix
• Abscess
• Ectopic
• Surgical management of miscarriage

Of course there are others, and the relative frequencies of these vary between departments and populations, but either way you're going to be anaesthetising a lot of people for abscess drainage over your initial years as a solo anaesthetist.

It's weirdly tricky

If you've witnessed a senior colleague demanding to know why an I+D of a superficial abscess can't be done under local anaesthesia, it's not because they're choosing to be a cruel and malevolent gatekeeper of the etheric goodness, but because it's one of the few times where the anaesthetic can be vastly more complex and dangerous than the surgery.

For what is an incredibly simple and usually straightforward surgical case, it's actually really rather difficult to anaesthetise a painful I+D particularly smoothly, for a bunch of reasons: