NOTES - Surgical Procedures :
anesthesia or spinal? - - Posted by lam651 (lam651), 19 August 2003
When I've had my surgeries the anesthesiologist always asks me that. They say some people like one or the other. I've heard a lot of people have nausea problems with anesthesia.
I've only had anesthesia and it's worked pretty good for me. I've never had nausea problems and in a few days all of the effects seem to wear off.
But, there is one problem. When I wake up after my surgery I have the worst pain for at least 1 hour. One time it lasted 18 hours before they got it under control. I wonder if this is just the way it is with anesthesia and it can't be helped. With a spinal do you still have to go through that painful transition between being unconscious and awake?
With more surgeries in my future, I'd like to hear other peoples ideas about which works best for them. Thanks, Larry
Posted by Erin (Erin), 20 August 2003
Larry, Ive had two surgeries, one on my left knee and the other on my right ankle and both were with general. But with both Ive waken up with horrible pain and then they released me to go home, so I was still in horrible pain at home, no relief. But I never had a choice, but if I did I might opt for the spinal. What Ive seen before, most people like the spinal better. It will be interesting to see what others have to say.
Good luck with the other surgeries,
Erin
Posted by hmaxwell (Heather M.), 20 August 2003
Larry,
I wouldn't have the spinal if you paid me.....but there are cases (like a TKR) where that type of anesthesia is recommended for post-op pain control. I've never had any serious problems with pain control, nausea, or anything really following general anesthesia.
My brother had a week of terrible headaches and coming to the point of passing out after knee surgery with an epidural. This is a rare complication caused by interruption of the spinal fluid. If you aren't going to be active post-op, it probably isn't an issue. But between him and my roommate who had spinal fluid leaking out for 2 days post op...well, I wasn't impressed with the whole needle in the back thing.
My mom wouldn't go any other way. General anesthesia makes her violently ill and can even send her into shock.
I guess my point is that you need to discuss all your medical needs and concerns with the anesthesiologist to decide what's best for you. One thing, which was news to me, is that even with an epidural they still sedate you to the point that you are out. I figure if I'm going to be out, I'd rather not have a needle stuck in my back. But people like Sylvia who had a TKR need the post-op pain relief offered by an epidural.
Hope I haven't confused you more. If post-op pain control were not an issue (i.e. a relatively minor procedure) I would only go with a general. I've never had any issues. But the pain control that you are talking about could probably be addressed with an epidural, so you should talk to the anesthesiologist.
Heather
Posted by OhioStateMel (OhioStateMel), 21 August 2003
Larry:
I too have unmanageable pain when I wake from general anesthesia. I was given the option of a femoral nerve block to be administered during the surgery- however, I was concerned about the risks, so I decided against it. Oh boy did I hurt when i woke up after the TTT. The anesthesiologist ended up administering the femoral nerve block when I was awake- and let me tell you- IT IS A GODSEND. I was virtually pain free for 8 hours. I would definitely discuss this with your dr.
Take care, Mel
Posted by abaddon_bast (abaddon_bast), 21 August 2003
i think that pain is normal since i had bad pain when i woke to from my surgies it took 2 day before it went away total and it was bare able about 3 hours after the surgeyr bakc when i was in my own bed
Posted by Jillian24 (Jillian24), 22 August 2003
Larry,
I have had several surgeries and with my tonsils,wisdom teeth and my first knee operation I had geneal. I was sooooo sick, that they had keep me over night due to how sick I was. And the effects last way way to long. Then one week post op I found out that I had a staph infection and I had emergency surgery. They told me I had to have a epidural because I had eaten. It was the best! Now I have had 8 all together and I love them. You can either be awake for surgery or be asleep. I have never felt a thing and I was totally asleep. I highly recomend it! I had good pain control and never had any problem.
It is something that you need to talk in depth with your doc about. And sometimes you can set up a appointment with the anesthesiologist and ask them. Good luck and let us know~Jillian
Posted by wofford99 (wofford99), 27 August 2003
I am having my 13th knee surgery in about 2 weeks with a new orthopedic surgeon. It will be arthroscopy to clean out as usual. The doc wants to do a femoral nerve block with IV sedation. My question is will they give me IV medication before they put the nerve block in because I will be a nervous wreck as usual! I would appreciate any feedback! Thanks! Margaret
Posted by lam651 (lam651), 27 August 2003
Sorry Margaret, I can't help you with that. You might want to start a new topic to get more people to see that. Good luck, Larry
Posted by charlesbigford (charlesbigford), 12 September 2003
They give you some verset before they do the nerve block and you will be pretty relaxed.It kind of hurts a little like you would think with a needle stuck in you but i have found it to be the best way to go. You get out of surgery not feeling sick to you stomach .And you wont really have any pain from surgery .I don't even let the ask me i tell them the i want the nerve block. With one scope i was chatting with my knee surgeon and he was showing me what he was doing on the monitor and it was pretty cool. If you are not squeamish and i am not .Good luck Charles
Posted by ATsoccergirl (ATsoccergirl), 13 September 2003
Margaret-
They sedate you before they do the femoral nerve block. I'll explain a little about them if you are not famillar with them. They insert the needle in the femoral triangle of the groin. It is not particularly painful, but it is wierd. In order to make sure that they have the correct injection site, the needle is attached to a EMS machine. Depending on how the muscles contract once the electricity is turned on and the placement is correct, the medication is administered. I would not recommend them at all. I have had problems with them due to the fact that both times I had one, my quads completely shut down. This was very detrimental to my recovery and significantly lengthend the time.
I have seen athletes quickly recover from surgery using an epidural. The Ortho I work with likes to use them on simple arthroscopic procedures. I had an athlete last year, have surgery in the morning and be out at the bars in the even. Not to say he was supposed to do that, but he was feeling good enough to be out. There are some complications, the most common being headaches. For me, an epidural is not a good options since I have had some rather serious concussions. You might want to discuss some other pain control methods such as a PCA pump or other medications that be administered during surgery.
Posted by wofford99 (wofford99), 14 September 2003
Thanks so much for your reply. I appreciate it! This is my 13th knee surgery. I have had general in the past for the patella realignments and scopes. I had no choice. I get terribly sick but they had to do extensive scopes. In fact, I have to be hospitalized for nausea due to general.
I am already in pain management and have somewhat of a tolerance to some medications. The dosages of versed, fentanyl,etc. usually have to be increased for me but that's not a big deal.
I had a femoral nerve block in my 3rd knee surgery when I was 12 years old (15 years ago) and I remember waking up from the conscious sedation and being so scared. I am concerned about the quad muscle because mine already is not firing.
I am having fairly extensive surgery. Most of the cartilage has degenerated off the back of my kneecap even after the realignment. I know that the femoral nerve is not the only nerve that innervates the knee so that is what concerns me. Several other smaller nerves also innervate the knee and they will most likely not be numb.
Thank you again for your information. It helps to calm my anxiety! Thank you! Margaret
Posted by ATsoccergirl (ATsoccergirl), 14 September 2003
Margaret-
Have you ever had an adverse reaction to morphine or been on it before?
Since you are having such an extensive surgery, I would highly suggest a PCA pump. PCA or patient controlled analgesia, delivers low levels of morphine when you feel that you need it. You have a button that you can push when ever you feel pain. There is a limit to how much you can press it within a period of time so you cannot over dose. From clinical studies, this method overs a much better control of pain than larger doses of morphine. WIth the constant level of medication in your system there are no ups and downs with pain as is common with other methods (injections, pills, etc). It has been shown that actually less morphine is used during the stay, and pain levels are significantly less.
Another option which could be done along with a PCA pump is an IV injection of Toradol during the surgery. This is a powerful anti-inflammatory. It works well for pain management after surgery as long as it was used IV. There is something about the makeup of the drug that requires it to be used IV before it can be used orally.
Finally, remember that Ice is extremely important as an analgesic. Make sure you have a good supply of it, or if you can get your hands on a cryo cuff or similar machine, even better!
Posted by ruglesich (ruglesich), 18 September 2003
hi. i had a medial retinaculum repair surgery last
week and opted for the epidural route. they sedated
me before hand so i don't remember much of it.
after surgery, they administered a femoral nerve
block which was a godsend. when it finally wore
off (~24 hours later) that's when i first started
feeling the pain. my anesthesiologist told me
that even if i had elected to have general anesthesia
he would still have given me a femoral block for
pain management. you should discuss this with
your doctor. one thing about the epidural is that
they might have to keep you in the outpatient
recovery room longer than with general anesthesia
because they have to make sure that you've
recovered bladder function before they can release
you.
- rob
Posted by wofford99 (wofford99), 19 September 2003
Hi Rob-
I had my surgery on Wed. morning at 7:30 and my nerve block has not worn off yet. It's been 48 hours. I called my doc and he said sometimes it takes longer but to call him tomorrow if it is not better. Margaret
Posted by neil (neil), 27 September 2003
i have had nerve block, anesthesia and a spinal/epidural. i hated the epidural because as you come down from the morphine you go thru withdrawels which were very unpleasant for me. doctor told me my reaction was similar to that of an addict needeing a fix. no thanks i do not need to relive that, nerveblock worked well, except be prepared for when it wears off. i had demoral as well as nerve block, so i think you should judge on what you want, added issues besides pain from spinal or just dealing with pain management with others. good luck
Posted by msumma1 (msumma1), 3 November 2003
I am facing surgery in December for the second time on my right knee. My doctor wanted a spinal, but agreed to general if I can get the enesthesiologist to agree. The first time I had general with a morphine block, and I did fine. I frankly don't want to be awake for any part of this, and I don't want the problems I have heard may occur with a spinal. Does anyone know if anesthesiologists usually go with patient preference? My injuries are significant enough that my doctor says I have no choice but surgery, and I am very worried about the anesthesia issue.
Posted by Heather (Heather), 3 November 2003
Msumma,
You ALWAYS have a say when it comes to getting knocked out. Sometimes the surgeon's have preferences, however, it is your call. I recently had a TTT and a quad tendon repair revision and I hated to be put under. I had had 5 other surgeries all of which I was knocked out. This time I expressed my fear and I had an epidural along with heavy sedation through IV. I don't like the idea of a machine breathing for me. I was out the whole time and don't remember a thing. I woke up feeling much better than if I had been totally under, ex. groggy, cick to my stomach, dry mouth. Also having the epidural helps with pain relief after the surgery. There are risks with any type of anesethia. Be sure to be informed by your OS and your anesethiologist, but like i said, it's your call.
Good luck!
Heather
Posted by msumma1 (msumma1), 3 November 2003
Heather,
This reassures me so much. For me, the thought of knowing anything during the surgery is the most frightening part of it. I was completely out under general along with a femoral block done after I was out the first time. I didn't have any side effects of the anesthesia, even though I am aware that respirations are taken over by a ventilator with a general. I will probably be staying in pretty close contact with you all through this. Even as a newbie, I am already feeling much better with the support and information I have found here. Thanks again!
Mari
Posted by Heather (Heather), 3 November 2003
Mari,
I'm glad you have found support here. Please feel free to keep in contact as I will be curious as to how it all goes for you. I'll be pulling for you!!
Hugs,
Heather
Posted by Jennifer_G (Jennifer_G), 24 November 2003
I would take a femoral nerve block any day over an epidural! I must have reacted very badly to the epidural so my experience is the worst case scenario. I woke up from surgery violently shaking and had to be given something to relax me. I then was itching so badly I was making myself bleed and was unable to urinate for about 12 hours after surgery (muscles were still affected). The nerve block lasted 24 hours and was a piece of cake when they gave it to me and no real after effects.
Posted by bethg79 (bethg79), 15 December 2003
You guys are scaring me now!
I'm having a plica removal and general clean-up on 12/30. I had my preop appointment, and they told me there that I was going to have a general ... apparently that's all they do at the clinic I'm going to.
They also told me that I would be given "a mild painkiller", but they didn't name it...what painkillers were you guys given to go home with? Did they work well or no? They are only going to keep me from 1/2-3 hours after my surgery (until I'm awake), and I'm terrified of going home in unbearable pain now!
Bethg79
Posted by apaininthekee (Missy0503), 15 December 2003
Hey there, I understand how you are feeling. When I had my surgery I was told it would be out patient as well. I was terrified!!!! I have a low pain threshold and a high tolerance to pain meds, alway have even as child. When the anathesiologist came to talk to me before surgery I told him about my fear. He told me he would talk to the doctor for me. Apparently my doctor listened because they decided to keep me for a few days to make sure I was not screaming with pain. I don't know if this helps, but I would talk to those folks working with you. Thats what they are there for. Good Luck
Missy
Posted by bethg79 (bethg79), 20 December 2003
Missy,
Sorry for replying so late...I'm a married grad student, which means not a lot of time on my hands!
Thanks for your advice...I don't know if I have a high tolerance for pain meds, as I've never been on anything heavier than advil! However, both my grandmother and mother have a high tolerance...my mom had two back surgeries, and it took them over two times the normal dose to knock her out :/
I'll definitely talk with the anesthesiologist when I go in, but I don't think they're going to be able to keep me overnight...I'm going to an outpatient clinic for the surgery, which means they aren't equipped to keep people overnight. However, they're directly across the street from one of our major hospitals, so if it turns out they absolutely need to keep me, I'm sure they'll transport me over there. (Of course, that's if my insurance will allow them)
What kind of painkillers were you given after the surgery? My informational packet says "you will be given a prescription for a light pain medication"...but I don't know if they count vicodin as "light".
Man i'm so nervous about this now...just over a week to go, and part of me wants to call and cancel the surgery. But then I end up limping my way in to lab from my car, and seeing how hard it is to do anything in my glovebox while i'm sitting on a stool. And they're not even sure how much getting my plica removed is going to help!
Posted by dawnb1968 (dawnb1968), 20 December 2003
Hi,
I had a partial meniscectomy on Dec 2, and I was very nervous before hand also. I had never had any kind of surgery before. I was given the spinal anesthesia and I remember being rolled into the OR and the nurses and my OS talking to me for a couple of minutes, then I remember waking just as they were rolling me out of the OR.
I was feeling pretty good until the nurse gave me some pain medication and it made me sick a little while later and a while after that I started itching a little bit which they gave me benadryl for. I tried 2 different pain meds in both cases they made me sick so I didn't take anything after the first day and a half, and I didn't need anything. I had very little pain and I took Advil or Motrin for the aching I did have.
I would definitely go through with the surgery, I mean if there's a chance that it will do some good it will be worth it !
Good Luck !
Dawn
Posted by mary123 (mary123), 20 December 2003
HI!
I have had both - general and spinal anesthesia. I have had no several pains after these anesthesias. I think it depends of the pain placates. But I never want to have general anesthesia again. Last time it was so awful!!! At the middle of the surgery I woke up. I just could not move anything and open the eyes. I heard everything. And I feel something, too (not a strong pain bacause before general anesthesia spinal anesthesia was done). But the biggest problem for me was that I could not respire. Saliva went to my respiratory ways and i want to cough but I could not because the hoses. It was terrible. I got so little air and during the operation and after it I felt me awfully. I could not note to anybody in anyway that I was not sleeping and I need extra anesthesia. That's way i prefer spinal anesthesia. But with it I had this problem that it didn't worked for me so quicly as it should and anesthesist should do me general. With spinal anesthesia I see and heard almost everything and this doesn't scare me. It's ok. And I feel no pain, too.
Posted by JRXZ (JRXZ), 25 December 2003
I'VE HAD 2 ZIMMER PARTIAL KNEES SINCE SEPT 03. I RESEARCHED THE OPERATION AND CHOSE A ZIMMER SUGGESTED DR. I'M 4 WEEKS IN RECOVERY ON THE 2ND KNEE AND VERY PLEASED, W/ 132 ROTATION. I LOOSEN THEM UP IN THE MORNING, BUT LESS OF A PROBLEM EACH DAY. I'M SURPRISED MORE PEOPLE DON'T DISCUSS SELF CONTROLLED MORPHINE IV DRIP. IT WAS WONDERFUL, WAS SET UP WHEN I AWOKE. GUESS I DIDN'T KNOW THERE SHOULD BE PAIN. NO HIGHS, NO LOWS, NO SIDE EFFECTS. WENT HOME W/ PERCOSET AND USED IT AS NEEDED. I WOULD AWAKE AT 2:30 AM EA. MORN, IN PAIN,TAKE THE PILL AND 20 MIN. LATER WAS WITHOUT PAIN. NITES WERE THE HARD PART THOUGH. I FOUND DICLOFENAC, (NSAID) DID MUCH TO CONTROL INFLAMATION & SWELLING. I'M STILL WORKING ON QUAD STRENGTH FOR GOING DOWN STAIRS NORMALLY. I'M USING A CANE, MORE FOR SAFETY THAN NEED. I GREATLY FEAR A FLUKE WHERE MY KNEE WOULD FAIL AND DROP ME. THE DR DECIDED TO CLOSE MY SECOND INCISION W/ A SURGICAL TAPE; I HAD A REACTION TO THE TAPE, FOR 2 DAYS, (FLU ?) AND WAS IN MINOR SHOCK BY THE TIME I GOT TO EMERGENCY. 15 MIN. AFTER BEING IV"D FOR MORPHINE I FELT FINE. 2 MORE DAYS IN THE HOSPITAL.
Posted by Clarkey (Clarkey), 29 December 2003
Hello Beth,
Just want to wish you luck tomorrow with your 1st every surgery. Hope your OS sorts your knee problems and can start 2004 not worrying anymore about your surgery. Understand that you are feeling scared and nervous right now as I am sure most Members would also be feeling this the day before surgery. So far I manged to get away from any type of surgery but might also have to face it, that I dreading, have a great new year, Nick 
Posted by bethg79 (bethg79), 29 December 2003
Thanks Nick! I'm really glad that I found this site, both for the information and the support that we get here.
I just got my "arrival time" from the clinic - 10:45 tomorrow morning. Which means I'm gonna be REALLY FRIGGIN THIRSTY by the time I get there :~(
I'm not worried about the surgery as much as I am the pain afterword. I'm hoping that they give me something as strong as percoset. I'm also worried that the recovery is going to take longer than the 3 days they told me...if it does, that means I'm going to have to take a leave of absence from my school, and I can't afford to lose my stipend right now. Ok, and I'm a little afraid of going under a general anesthetic...seeing as I've never had one I think that's understandable.
Thanks again for your support Nick, and I hope that you can find a non-surgical route to fix your problem!
Beth
Posted by surgeryXseven (surgeryXseven), 27 February 2004
I like the spinal, unless you get really freaked out in the O.R. I like being awake and hearing whats going on, plus it puts the docs and nurses on their best professional behaivor. 
I used to circulate in the OR as an RN, its just a little safer being awake. I had numerous scopes, HTO, and a failed meniscus allograft (wrong meniscus sent, left leg instead of right), all awake. They relax you pretty well, and you can get a first hand report of what things look like in there, real time, otherwise the guy see's you after doing 10 other cases that morning and can't remember your knee from the grandma's knee replacement in the other op room.
Posted by Beauzer (Beauzer), 27 February 2004
I personally had a really bad spinal experience, which I won't share in detail (unless you really, REALLY want to know) except to say that I sure wouldn't do it again.
Danielle
Posted by wetherel (wetherel), 18 July 2004
I had two options:
1. general anesthesia
2. general + nerve block.
I was told the nerve block is like an epideral for the leg only, that helps reduce pain for some time after surgery.
The block is an elective procedure, which I assumed would cost me extra money, so I didn't do it, because I'm cheap.
I had no pain after the surgery, probably because of the percocet pain killer I was on, and whatever they put in the IV.
Updated Sat Nov 7 2009
