This is a great question, and I hope that you don't feel alone in your fear of needles (which is actually fairly common). There are immense differences between local and general anesthesia. First of all local anesthesia is typically injected (but can be applied topically in certain locations) and it acts "locally" to block the transmissions through sensory nerve fibers. This means that while the physician is working, you shouldn't feel the sensation of pain, but you may still feel the pressure of them tugging, etc. Of course local anesthetics don't do anything to your mental status, so you are awake and aware of everything that is taking place (unless your physician gives you something extra for this). Local anesthetics are what most dentists
use while working on your teeth (for cavities, etc). General anesthetic in contrast is when drugs are given that reversibly cause a loss of consciousness. It is not a local phenomenon, but rather a global process. Meaning that once you are fully anesthetized, a surgeon
can operate anywhere on your body, and you shouldn't feel, not be aware of anything that is going on. Due to the fact that it is a global process there are most risks and potential complications to a general anesthetic. For instance with local anesthetics, there are rarely global physiologic changes due to the anesthetic that can hemodynamic instability (blood pressure changes) that can potentially be very dangerous. For this reason local anesthetics are used safely in the office setting. General anesthetics require a trained anesthesiologist
to be present at all times, and to monitor the patient closely (blood pressure, temperature, respirations, etc). Frequently anesthesiologists have to intervene and give blood pressure medications for a short time. This doesn't mean that general anesthesia isn't safe, because overall the complication rate is very low, but there are very real potential risks that every patient needs to know about. I would recommend discussing the risks/benefits with the anesthesiologist that would do your surgery. I hope that this was helpful. Best of luck.