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Offline JenSinclair

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Anaesthetic questions...
« on: May 21, 2005, 01:33:53 PM »
Hey, everyone.  I'm a little less than 4 weeks from my op date, and I'm getting all OCD about anaesthesia (surprise, surprise!).  Just wondering what all of you have had...from what I understand, the options are:

General
GA with epidural/spinal
GA with peripheral nerve blocks
Twilight with epidural/spinal
Twilight with peripheral nerve blocks

I'm thinking either twilight with peripheral blocks or general with peripheral blocks (femoral and sciatic).  My OS said that it's basically my decision (to be made in consultation with the anaesthesiologist), and that he doesn't have a particular preference other than my comfort level with the type of anaesthesia.  So...

Opinions?  Experiences?

Thanks in advance, and
Peace,
Jen
LR/TTT 3 August 2006, RK
LR/TTT 16 June 2005, LK
CPMs are evil.

Offline Beauzer

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Re: Anaesthetic questions...
« Reply #1 on: May 21, 2005, 03:04:34 PM »
Lots of experience (unfortunately).  Shoot, I can even rate the different induction agents...

It's actually unusual to have a spinal/epidural and a true GA.  Here's my thoughts.

general - common, safe, works well - makes me puke and shiver upon waking up, which sucks - finally found a good combo of drugs (working extensively with the anesthetist) on this last one

GA with peripheral block - what I had for my OATS - I don't even remember getting the block (or even being in holding for that matter - gotta love versed and dilaudid!) and was pretty comfortable postop - didn't have bad pain until the block wore off (at home the next day)

Sedation and Epidural/spinal - works well for a lot of people  - find out how comfortable your anesthetist is with doing them - personally I had such a bad experience with one (which didn't work and a jacka** anesthesiologist who didn't believe me) when I had my ACL done that I can't even watch somebody else get one 8 years later without nearly passing out

sedation and block - not good for long or very painful procedures - although, the new agents they use tend to have a very fine line between twilight and GA (meaning a lot of patients undergoing "twilight" are actually out enough it should be called GA)

~D
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline JenSinclair

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Re: Anaesthetic questions...
« Reply #2 on: May 21, 2005, 04:31:44 PM »
I think that kind of solidifies it -- GA and peripheral block...and they'll have to sedate me to do the blocks.  I'm more afraid of actually GETTING the blocks than anything else.  I don't want a spinal/epidural because I'm a little freaked out about the idea of being numb bilaterally.  So, basically...when I start to feel my foot, I should start taking pain meds?

Peace and thanks,
Jen
LR/TTT 3 August 2006, RK
LR/TTT 16 June 2005, LK
CPMs are evil.

Offline Beauzer

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Re: Anaesthetic questions...
« Reply #3 on: May 21, 2005, 05:02:50 PM »
Well, the blocks (I've had 2 now) wear off instantaneously.  I went from absolutely no pain to screaming in about 3 seconds.  Make sure to ask your anesthesiologist exactly how long the block should last and then plan accordingly.

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline JenSinclair

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Re: Anaesthetic questions...
« Reply #4 on: May 21, 2005, 06:24:55 PM »
Hmmm...any thoughts about a unilateral spinal?  A friend of mine who had the same op by the same OS at the same hospital had a spinal and twilight...the spinal lasted about 12 hours, but she was numb from the waist down so she didn't know whether she had to pee or not.  I don't think I could handle that, but I've read about unilateral spinals.  Of course, some of the research seems to indicate that if a sufficient volume of the anaesthetic agents are used the peripheral blocks should last about that long as well.

Is it worth a phone call to the anaesthesiology department at the hospital beforehand, or should I just write it all down and ask them the morning of the surgery???

Peace,
Jen
LR/TTT 3 August 2006, RK
LR/TTT 16 June 2005, LK
CPMs are evil.

Offline cat

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Re: Anaesthetic questions...
« Reply #5 on: May 22, 2005, 12:27:44 AM »
I had a spinal with something to make me sleep. Just the one leg was numb. I liked it. I would like to have a spinal, without the sleepy stuff, when I have my screws removed.
cat
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline Mandy

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Re: Anaesthetic questions...
« Reply #6 on: May 22, 2005, 01:36:22 AM »
i just have had spinals for both of my sugeries and am planning on having another spinal with my left TTT on June 2nd.  i was given the spinal first off and then during my TTT i asked for more sedative because i could kinda feel what was going on with my leg and didnt like that feeling! ::) :P  im assuming thats what i'll be doing for my upcoming TTT.

good luck with everything!!!
~Mandy
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)

Offline JenSinclair

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Re: Anaesthetic questions...
« Reply #7 on: May 22, 2005, 02:08:39 AM »
See...that's the thing.  I don't want to be aware AT ALL of what's going on.  Not hearing, not smelling, and DEFINTELY not FEELING.  I'm thinking GA and either unilateral spinal (though I have read they fail quite often) or with peripheral blocks (sciatic and a three-in-one femoral seems to work the best, according to the research I've read).  Apparently, if they give you an adequate amount, the blocks can last for up to 14 hours.

Time, methinks, to put the leg up.  I spent the late afternoon and early evening gardening.  This is a highly suspect activity for me -- I tend to kill everything green...but it was a handy excuse not to write my final exams today (which MUST be done tomorrow!).  Now, of course, my knee is REALLY swollen and even more unstable than usual.  I think this means that it's time for TV and maybe some Advil.

Peace,
Jen
LR/TTT 3 August 2006, RK
LR/TTT 16 June 2005, LK
CPMs are evil.

Offline sweetheart0517

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Re: Anaesthetic questions...
« Reply #8 on: May 22, 2005, 03:15:29 AM »
Hi I dont know if this helps at all but I had general anestesia for my surgery because I was so afraid I was going to hear something or feel something is I was to stay awake. But I also did hear that if you opt to have the spinal you can also receive a seditive to calm you down and people have actually told me they dont remember anything from just the mild seditive. If you are worried about going completely under then I would say take the spinal but honestly in my opinion the general was the best thing because I dont remember a darn thing one second they were telling me to take a deep breath the next minute they were telling me to wake up it really is easy. Well I wish you all the best with your surgery and if you have any questions about the general anestesia please feel free to ask I can let ya know anything. Good Luck!!!!

~Laura~
Lateral release 1-12-2005
Pt for what feels like forever...

Offline sharon_g

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Re: Anaesthetic questions...
« Reply #9 on: May 22, 2005, 03:21:39 AM »
I had the general with a block for my ACL reconstruction.  No issues other than I didn't feel like leaving the hospital and felt a bit like throwing up in the car ride home.  I had no issues with the block wearing off, because they gave me percoset before I left, and I was able to have a nice overlap.  I had something, maybe the twilight for my scope - I was supposed to be aware, but I don't remember anything.  I wanted to watch what they found on the monitor.

I had an epidural while having kids and I felt pressure well, which really sucked, but no pain.  I also thought hearing the drill would be too much.

Like all anethesia, there are pros and cons to all, and one will probably be best for you, but maybe not for someone else.

R TPFX-Type I/II-No Surgery,stress fracture - 01/04
Scope 05/04- meniscus cleanup,femur,tibia and patella cartilage shaving, femoral cartilage degeneration
MCL Strain (Healed Long)
ACL hamstring reconstruction (healed long) - 4/21/05

Offline JenSinclair

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Re: Anaesthetic questions...
« Reply #10 on: May 22, 2005, 01:23:40 PM »
Thanks to all for your replies.  I think I am fairly sure on the GA + peripheral blocks.  I'm going to make darned good and certain, though, that they use bispectral index monitoring (BIM) because my sister had anaesthetic awareness once -- albeit nigh on 40 years ago, and my brother always required twice the normal dosage of GA agents to put him under.  They are half-siblings, so I don't know whether that comes from our mother's or their father's side, and mum has been gone a long time...so I can't ask. (My parents were married to different people, both had two kids, then were widowed, married each other and had me...then when my mum died my dad married a woman with two kids...so I'm either an only child or one of seven...depending how you look at it)

I had twilight once, and while I don't remember anything...it was minor surgery that didn't involve saws, chisels, drills, or screwdrivers.  I recall being a nervous wreck when they asked me to move onto the table, and I know that I woke up from it faster and more lucid than average (they told me so).  This all combines to tell me that I need GA and blocks -- the blocks for post-op pain more than anything else.

The dog is asking to go out, so I'd better take him before he pees on the new oriental rug (which would result in his immediate death).

Peace,
Jen
LR/TTT 3 August 2006, RK
LR/TTT 16 June 2005, LK
CPMs are evil.

Offline casey2291

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Re: Anaesthetic questions...
« Reply #11 on: May 22, 2005, 11:49:02 PM »
Hey,

I just thought that I would throw in my two cents worth.  The day of my surgery, I thought that I was going to go with general anesthesia.  I voiced my concerns about vomiting after anesthesia because I get motion sickness very easily.  The anestheologist said that I had a moderate chance of that happening since I was a young woman.  She and the doctor talked me into a spinal (which I was nervous about), but it was great.  I was numb from the waist down.  It took about about 4 hours for it to wear off.  I spent about three hours in the recovery room.  Not being able to move from the waist down was a little bizzare, but for me it was well worth it to know that I was not going to wake up vomiting.  I choose to watch my surgery (I know not what you want).  I wasn't able to feel anything until they started to drill the holes into my bone.  Then I felt some pressure, but no pain.  Other than than, I would have had no idea that they were doing anything to me.  They did give me some sedative before I went into the OR.  That stuff calmed my nerves immediately.  They were going to give me some more as soon as I was in the OR, but I turned them down.  I was also told that if at any point I wanted to be put under to just let them know.  Good luck with your decision. 

Casey  :)
LOA #2 and hardware removal 12/15/08-new cartilage from ACI looks "GOOD"
LOA on left knee 3/18/07
ACI and HTO on left knee 10/22/07
scope of right knee on 6/21/07
microfracture left knee 3/18/05

Offline Beauzer

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Re: Anaesthetic questions...
« Reply #12 on: May 23, 2005, 02:21:35 AM »
If you have trouble with nausea and vomiting postop with general anesthesia (like I do, big time), let the anesthesiologist know.  They can give you stuff to prevent it.  I had a scopolamine patch (the stuff you use for air sickness), and a whole bunch of other stuff (not sure what it all was) the past two times and I haven't had any problems at all.  The time before I didn't get anything for it and after the pain medicine in the recovery room I threw up for 5 hours.  Bleah!

Danielle
32 - R knee gone to hell
lat. meniscus 94
ACL, chondroplasty 98
Chondroplasty 99
Screw fell out into joint, med. meniscus, microfracture 99
MCL/med. capsule recon, med. meniscus 00
Chondroplasty 04
Chrondroplasty 1/05
OATS 4/05 for OCD lesion
AVN, MFC fracture 10/05

Offline JenSinclair

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Re: Anaesthetic questions...
« Reply #13 on: May 23, 2005, 02:37:59 AM »
Since I've never had a GA, should I ask for the stuff to prevent nausea off the bat?  I mean...an ounce of prevention and all...

I had an ulcer years ago and recall with agonizing detail the IV compazine...it made me pass out cold.

Peace,
Jen
LR/TTT 3 August 2006, RK
LR/TTT 16 June 2005, LK
CPMs are evil.

Offline stgiles16

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Re: Anaesthetic questions...
« Reply #14 on: May 23, 2005, 03:52:12 AM »
I have had 9 surgeries so far,,,,,,,,, all genearals except one and it was an epidural (which didnt work, followed by a spinal),,, NEVER AGAIN.I had a terrible experience with it. I have gotten sick post general anth. but now the drs have figured out a combination of meds that prevents the puking LOL :P I also had a block with one of my knee surgeries and it was wonderful. My knee didnt hurt for 24 hrs. I hated when it wore off. I wish that I had had one for every surgery. I had no ill effects from the block or even a bruise. They did it after I was asleep.

I would definately ask the ansth. DR to give me something for nausea ,,,, just in case.

goodluck
missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012