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Author Topic: GA.....Spinal.....epidural....?  (Read 2290 times)

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Offline BridgetJones_uk

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GA.....Spinal.....epidural....?
« on: August 14, 2005, 05:54:43 PM »
Hmmm....I've been given an option to not have a GA (though my OS said he prefer me to be knocked out unless I promise not to talk to him! and hes already asked if his new med students can watch (they're two yrs below me....great!)). The other options I was given was spinal or epidural and I still don't really understand...... what have other people had and are they better compared to GA.

Also have read about low pressure headaches.....whats that all about...?

confused....... I am!

Hope your all well.

M
xxxx
Trauma - Dislocation '96
Chondromalacia, PFS '01
Shallow trochlear groove, Patella Alta & tight ITB dx '03
Right Modified Galeazzi, LR and scope 2004
Left Modified Galeazzi, LR  2005
Redo Modified Galeazzi, LR and scope and medial reefing 2007
Right redislocation 2014

Offline Mandy

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Re: GA.....Spinal.....epidural....?
« Reply #1 on: August 14, 2005, 06:04:15 PM »
hey there~

for all three of my surgeries, i have opted for the spinal anesthetic.  for me the choice was really easy.  i have lung problems so i have to avoid general anesthetic as much as possible.  i also thought it would be interesting to watch my surgery on a TV, but thats just me!  :)  all in all, i am VERY happy that i had the spinal rather than general.  i was more alert after surgery and a whole lot less groggy and foggy. 

i think those headaches that you are referring to are what happens with the spinal.  correct me anyone if im wrong please! but i was always asked to pay attention if i happend to get a headache right after surgery as that may be from fluid leaking from the place the spinal was done.  i've never gotten a headache after surgery, but i think they just warn you so you can be aware if anything happens.

i wish you the best of luck wiht your surgery!

hugs,
~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 Nettan

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Re: GA.....Spinal.....epidural....?
« Reply #2 on: August 14, 2005, 07:22:16 PM »
I prefer GA, but for pain is better having spinal so you can continue having good painmanagement after.
Good luck wether you choose. I would go for spinal if you have a surgery which can cause lots of pain but for a simpler meniscectomy I would go for GA as you are allowed home earlier with this.

Hugs Nettan  8)
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline rickm

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Re: GA.....Spinal.....epidural....?
« Reply #3 on: August 14, 2005, 08:00:01 PM »
I've had GA, spinal and epidural.  Personally, I prefer the spinal or the epidural.  Any concern I had about being freaked out by "seeing" what was going on during the surgery was misplaced.  The other drug that was flowing through the IV tube in my arm (Versed?) rendered me incapable of freaking out.

My recovery from the epidural was faster than recovery from the spinal (in terms of the numbness going away).  My recovery from the GA included headaches and a sort of mild, irritating wooziness for several days.  But that's just me.

--Rick
3/19/05 Patella fracture, splinted in Rome, Italy
3/23/05 Surgery in NY, wires & pins, etc.
4/22/05 PT begins. 0 degrees flex.
6/6/05 42 degress flex.
6/8/05 MUA
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10/21/05 131 degrees flex/released from PT

Offline BridgetJones_uk

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Re: GA.....Spinal.....epidural....?
« Reply #4 on: August 14, 2005, 10:20:23 PM »
Thanks this is all really good guys.

GA makes me so sick and they hate it cause my asthma flares up before procedures as I'm a wreck, also as some of you know, I have this big pain issue (my threshold is probably about zilch!)....I don't mind the awake factor as I've seen this procedure thousands of times (though i vommed the first time I saw semitendinous removed, it made the anaesthetist chuckle!)

Whats the difference between spinal and epidural.....(didn't realy pay attention) and how long does the numbness take to wear off.

Netten I had a lovely birthday thanks and have made a new rug for my new flat, thanks!Thanks for all your help.

M
xxxxx
Trauma - Dislocation '96
Chondromalacia, PFS '01
Shallow trochlear groove, Patella Alta & tight ITB dx '03
Right Modified Galeazzi, LR and scope 2004
Left Modified Galeazzi, LR  2005
Redo Modified Galeazzi, LR and scope and medial reefing 2007
Right redislocation 2014

Offline Mandy

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Re: GA.....Spinal.....epidural....?
« Reply #5 on: August 14, 2005, 10:36:35 PM »
general makes me sick too and like you part of my lung problems is my asthma!  can get frustrating no doubt!  for all three of my spinals it took maybe about 2 hrs in the recovery room for it to wear off enough to use the restroom.  after going potty, i was free to leave!

good luck
~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)

shadehawk

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Re: GA.....Spinal.....epidural....?
« Reply #6 on: August 15, 2005, 12:25:39 AM »
Hi,

I just had a knee surgery and they used GA and anti-neausea meds at the same time.  I had absolutely no problems with this method.  I felt great right away after my surgery.  I also had the femoral block high in the thigh and it really helps after surgery. 

The block lasts anywhere from 12 to 48 hrs.  Mine lasted the 48 hrs and was wonderful.

Good luck with whichever method you choose.  It is really nice to have options.

Shade

Offline Heather M.

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Re: GA.....Spinal.....epidural....?
« Reply #7 on: August 15, 2005, 05:42:39 AM »
I must come from the same stock as Shade!  I have no problems whatsoever if I'm given general.  I always ask for anti-emitic (Zofran is the brand name med of choice in the US) just to be safe, because I had a bad reaction to morphine after my apendectomy with general anesthetic and was in utter misery post-op--dry heaves with staples in your belly are NO FUN.  So now when I have a general, I just ask them to take care of the queasies.  I also ask the doc to use the lightest amount of meds possible, and I always wake up just fine.  Usually, I wake up as I'm being rolled out of the OR, or at latest in the hall on the way to recovery--so I come out quite quickly and I'm usually pretty lucid.  Last surgery was pretty long (involved a full on scope and then an open incision procedure), so I was a bit groggy.  And I had a lot of post-op pain after the single Demoral shot they gave me, so they just cut to the chase (not wanting me to suffer and especially not wanting the leg to flare with trauma from the pain).  I had a femoral nerve block, and it was WONDERFUL.  Amazing, incredible, can't say enough good things about it.  I had at least 36 hours of NO PAIN.  I was sitting up eating a cheeseburger and fries about 4 hours post-op in my hospital room--my parents couldn't believe it.

My brother and roommate both had spinals (I think--maybe it was the epidural?  I always mess them up--numbing medication put directly in the spine one single time for several hours of no sensation from the waist down).  My brother had spinal headaches that left him flat on his back for the next 7 days--every time he got up, he passed out or barfed or barfed and then passed out.  Scared his wife to death.  The doctor said this was a rare complication from the effects of disruption of the spinal fluid.  It's called a spinal headache, and it can be miserable.  Only thing to do is wait it out.  My roommie had her ACL reconstructed with a spinal for post-op pain management.  She ended up losing the clot that kept her spinal fluid in its place and bled out spinal fluid all over the sheets the first night.  Aside from freaking her out, she had a lot of general spinal pain, especially focused where the catheter went in, and had serious muscle spasms following the procedure in her mid-lower back. 

My neighbor just had a TKR with spinal or epidural (not sure which) and he also had terrible muscle spasms around where the catheter went in---so bad he was sedated the next day because he was in agony.

If given the chance, I will always choose a general.  I don't want to be awake, and I've not heard anything good about the post-op experience with epidurals or spinals (again, not sure which are the culprit--could be both) in the people I know.  On the other hand, though, lots of folks have had great epidural/spinal anesthesia experiences on this board.  The women I know who had epidurals for childbirth sing the praises of their anesthesiologists!  And they didn't have any bad effects--that's at least four women I can think of in my family alone.  So the knee folks had bad luck, the baby folks did okay.  Hmmmm.  Strange.  I think the skill of the doctor performing the epidural/spinal is a huge factor as well, along with personal differences that make one patient react well and the other have a complication or bad result.  It sounds like the vast majority of spinals/epidurals go just fine.

I think the most important thing to do is sit down and talk with the anethesiologist about what you want and don't want.  For example, some people want the spinal so they can stay awake, but the particular OS in question doesn't like patients to be awake so he always has the anesth. sedate the spinal patients so they are zonked anyway.  If you went into the spinal expecting to be awake and witness the procedure, you'd be pretty bummed.  That was the policy of my first knee surgeon, so I just chose a general.  If I'm going to be out cold, I'm going to do it without a needle in my spine and potentially a catheter.  And I'm going to boogie out of post-op as soon as I wake up and have my pain under control, rather than having to wait for my legs to wake up.

Just my take.  Everyone is different.  With breathing concerns, likely an epidural would be the way to go, but discuss it with the anesthesiologist. 

Heather
« Last Edit: August 15, 2005, 07:23:24 AM by Heather M. »
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
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Offline BridgetJones_uk

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Re: GA.....Spinal.....epidural....?
« Reply #8 on: August 15, 2005, 11:56:40 AM »
Thank Heather,

I've just had loads of bad experiences with GA, when I had my wisdom teeth out they couldn't wake me up, but I could hear what was going off around me and I know this because they were having problems with the moniters, also GA makes me so sick and I work my way through the anti emetic list and I'm still sick. Last year the hour and half home today procedure ended up in a three day stay in hospital (I did ask about having it under local...they laughed!) and whilst there having absolutely no pain control.....the only relief I go was from a morphine, dicofenac tramadol mix which meant I was pretty high most of the time but when I was discharged it was straight from that to paracetamol and brufen! Recently I've had oesphogititis which calcifed off part of my oesphagus and alot of throat infections and I know they don't tube you down that hole, but its getting better and I don't really want anything to go down there.

I also have little faith that the gas man will alay my fears. Last time I told him about the wisdom teeth incident and he just said everyones scared.....Great loadas help.

So I get a choice and was looking into it, I just thought there must be something that is better than the sickness of GA and the post op pain.

Lol

M
x
Trauma - Dislocation '96
Chondromalacia, PFS '01
Shallow trochlear groove, Patella Alta & tight ITB dx '03
Right Modified Galeazzi, LR and scope 2004
Left Modified Galeazzi, LR  2005
Redo Modified Galeazzi, LR and scope and medial reefing 2007
Right redislocation 2014

Offline stgiles16

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Re: GA.....Spinal.....epidural....?
« Reply #9 on: August 15, 2005, 01:40:37 PM »
I have also had all three kinds of anth. I defiantley prefer general. I did not have a good experience with the spinal or the epidural. I used to get sick after GA but now the drs give me the anti nausea meds and also use a patch behind my ear and i am fine. The spinal and epidural made me barf for two days. If given a choice , I personally will NEVER  stay awake for another surgery.

just my two cents worth.
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
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RA
in pain mgmt
TKR JAN 2012

Offline BridgetJones_uk

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Re: GA.....Spinal.....epidural....?
« Reply #10 on: August 22, 2005, 11:31:00 PM »
Had a thought, though it could be a kinda stupid one, what about a femoral and siatic block.....? therefore no GA or needles in my back (hospital has quite a high rate of MRSA even though everyone is swabed in and out grose I know!) and pain relief after.

Any comments anyone?

lol

M
xxxxx
Trauma - Dislocation '96
Chondromalacia, PFS '01
Shallow trochlear groove, Patella Alta & tight ITB dx '03
Right Modified Galeazzi, LR and scope 2004
Left Modified Galeazzi, LR  2005
Redo Modified Galeazzi, LR and scope and medial reefing 2007
Right redislocation 2014

Offline doglady606

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Re: GA.....Spinal.....epidural....?
« Reply #11 on: August 23, 2005, 02:55:49 AM »
I had GA for a scope, then feel good drugs, and an epidural for the Unispacer surgery.  I barfed after both! I must be sensitive, but I definitely didn't want to be awake.  I woke up during the Unispacer surgery briefly, remembered it clearly, and don't ever want to wake up again, arms strapped, knee strapped, just a kind of trapped feeling, IMO.  GA left my throat very raw too.  From the epidural, I was surprised when I came to my senses to have a catheter too.  Although I admit, I was grateful I didn't have to get up for the bathroom until the next day.
July 2004  Scope L. knee meniscus tears repaired(cut away), debridement, complete loss of articluar cartilage in medial compartment
Unispacer implant L. knee Spetember 2004
TKR right knee Nov. 08'

Offline Alla

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Re: GA.....Spinal.....epidural....?
« Reply #12 on: August 23, 2005, 01:55:16 PM »
Hey there

I had a GA and a Spinal block for my ACL surgery... both at once.  It was fantastic!  Im also asthmatic, so was worried about the effect anesthetic would have on me... but I came through ok.  The anethesist used a smaller tube in my throat apparently to reduce the irritation and reduce the asthma issues.  The Spinal block was to control pain after surgery..... and it sure did that.  I awoke after 50 minutes in the general... and couldnt feel my legs for the next 6 hours...so no pain!!  I'd do it that way again anyday.

Alla

 
Torn ACL December 04
ACL Reco May 05
Cleared to return to sport May 06

Offline Charliemouse

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Re: GA.....Spinal.....epidural....?
« Reply #13 on: September 02, 2005, 11:32:36 PM »
I had GA on Thursday (sept 1st)for a partial meniscectomy and a last minute nerve block that hadn't quite kicked in when I got to recovery(turns out I had blown my acl as well). I'm not sure I like the block as it is weird trying to walk and not knowing where your knee is (that's what it felt like to me this morning) but then if the pain I had in recovery is indicative of what I would be suffering now without the block I'll opt for the block when I get my acl done
18/06/05 Injured trampolining
Fixed Flexion 20-90 deg until...
01/09/05 lateral meniscectomy (40%)
09/06/06 Patella tendon aclr
09/09/06 Back on the tramp (carefully)
10 years on and still going strong
!!Stop twisting when you land or it hurts!!

Offline BridgetJones_uk

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Re: GA.....Spinal.....epidural....?
« Reply #14 on: September 03, 2005, 10:19:39 AM »
Thanks, though my friend who is studying working in anaethetics keep telling me that it should be spinal all the way, hes never had once so I have deemed him not competent to comment.

I still have a week.......but I'm sort of winging my way towards GA.....I mean, if they're gonna sedate me so much I'd prefer to be asleep and have a load of medazalam rather than be completely not with it, i think that would freak me out more. Also I consented to allow a couple of people to see the surgery.....due to the new incisions and I happen to be good friends with one and they are definitely not going to see me catheterized nor are they going to have a go.

Thanks for the advice and I'll update u all on what I decide, and if I ever get rid of this strep throat.

Got to rush off for coffee, with anasthetic friend.....we have a rule, that u don't talk about work, but I'm hoping today can be the exception.

Lol

M
xxxxxx
Trauma - Dislocation '96
Chondromalacia, PFS '01
Shallow trochlear groove, Patella Alta & tight ITB dx '03
Right Modified Galeazzi, LR and scope 2004
Left Modified Galeazzi, LR  2005
Redo Modified Galeazzi, LR and scope and medial reefing 2007
Right redislocation 2014