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Offline lam651

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anesthesia or spinal?
« on: August 20, 2003, 01:41:14 AM »
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
arthoscopy('99),HTO(tibia didn't heal 10/01),knee braces(7/02),HTO w/ex.fix. to repair tibial non-union(3/03), remove ex. fix.(9/03),HTO other leg(12/03)

Offline Erin

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Re: anesthesia or spinal?
« Reply #1 on: August 20, 2003, 10:44:19 PM »
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
7 years left knee pain/popping/giving out
10-20-00 L.knee surgery to tighten knee cap
2 years of right knee pain
9-13-02 Sprained right ankle
6-9-03 Brostrom-gould surgery on right ankle

Offline Heather M.

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Re: anesthesia or spinal?
« Reply #2 on: August 21, 2003, 01:40:21 AM »
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
« Last Edit: August 21, 2003, 01:41:30 AM by hmaxwell »
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Offline ohiostatemel

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Re: anesthesia or spinal?
« Reply #3 on: August 21, 2003, 04:16:41 AM »
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

Offline abaddon_bast

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Re: anesthesia or spinal?
« Reply #4 on: August 21, 2003, 04:41:07 AM »
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
Dislocated Right knee 2/28/03
Dislocated Right Knee 7/3/03
VMO adv. and LR w/scope on right knee on 7/21/03
Started PT on 7/30/03
Current ROM 130 as of 9/23/03
Curently in PT an doing good

Offline Jillian24

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Re: anesthesia or spinal?
« Reply #5 on: August 22, 2003, 06:32:27 PM »
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
ONE TTT LAST OCT
10 LR'S    ONE MEDIAL RELEASE
STAPH INFECTION.....MANY MONTHS IN HOSPITAL

Offline wofford99

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Femoral nerve block
« Reply #6 on: August 27, 2003, 08:02:57 AM »
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
-37y/o; multiple patella dislocations
-34 knee surgeries- bilaterally- fulkerson osteotomies/
right knee patellofemoral arthrosurface 2013

Offline lam651

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Re: anesthesia or spinal?
« Reply #7 on: August 27, 2003, 06:26:20 PM »
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
arthoscopy('99),HTO(tibia didn't heal 10/01),knee braces(7/02),HTO w/ex.fix. to repair tibial non-union(3/03), remove ex. fix.(9/03),HTO other leg(12/03)

Offline charlesbigford

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Re: anesthesia or spinal?
« Reply #8 on: September 12, 2003, 05:18:57 AM »
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
Quod tendon re-attached pulvorized femur, cortizon shots , 2 scops . lateral release with femur alograft inplant .

Offline ATsoccergirl

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Re: anesthesia or spinal?
« Reply #9 on: September 14, 2003, 12:44:08 AM »
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.
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline wofford99

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Re: anesthesia or spinal?
« Reply #10 on: September 14, 2003, 07:54:55 AM »
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
-37y/o; multiple patella dislocations
-34 knee surgeries- bilaterally- fulkerson osteotomies/
right knee patellofemoral arthrosurface 2013

Offline ATsoccergirl

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Re: anesthesia or spinal?
« Reply #11 on: September 14, 2003, 04:53:35 PM »
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!    
1999 LR, 2002 ACL/PLC recon, reversal of LR, 2004 ACL revision, 2006 Car accident torn PCL and small fractures resulting in bone chips in my knee.  Torn MCL 3 times.  Wicked screws under IT band and Pes Anserine.  June 2008-Hip Arthroscopy.

Offline ruglesich

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Re: anesthesia or spinal?
« Reply #12 on: September 18, 2003, 07:35:44 PM »
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

Offline wofford99

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Re: anesthesia or spinal?
« Reply #13 on: September 19, 2003, 05:48:29 AM »
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
-37y/o; multiple patella dislocations
-34 knee surgeries- bilaterally- fulkerson osteotomies/
right knee patellofemoral arthrosurface 2013

Offline neil

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Re: anesthesia or spinal?
« Reply #14 on: September 27, 2003, 08:51:25 AM »
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
9-13-02 - present, 4 surgeries to right knee. quad severed, piece of femoral condyle cut off, shaving of patella. had cartilage implant 9-22-03, fluid drain, cultures & manipulation10-21-03















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