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Author Topic: Do they do epidurals in the US for knee surgery?  (Read 2562 times)

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Offline soonpower

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Do they do epidurals in the US for knee surgery?
« on: March 25, 2011, 11:03:46 PM »
I keep reading that surgeons would give patients a choice of general anesthesia or epidurals for knee surgery. I already have been diagnosed with a torn ACL and need reconstruction. The doctor that I saw said he doesn't give epidurals, only general anesthesia. I asked another doctor and he said the same thing.

I live near Los Angeles, California. Are epidurals dangerous? How can I find a doctor that gives epidurals for knee surgery?

Last time, I had surgery, I had some bad side-effects with general anesthesia. Nothing major. I felt loopy and unnatural for two weeks after the surgery until the effects wore off.

Offline soozles

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Re: Do they do epidurals in the US for knee surgery?
« Reply #1 on: March 26, 2011, 01:59:26 AM »
I had my surgery done under spinal anesthesia with sedation. The spinal is kind of like an epidural, but goes a bit deeper, it's what they give for women who are having C-sections. The sedation they used was propofol, also known as the Michael Jackson stuff. You're breathing on your own, but you're asleep and don't remember it. They placed the spinal after the propofol, so I didn't feel anything from the spinal either.

Honestly, at the place where I had my surgery, most knees are done under spinal, very rarely do they use general anesthesia there for a straight forward operation. They do it with spinals or regional blocks. But, the anesthesia is not given by the surgeon, it's given by the anesthesiologist. The surgeon's don't always know or really care all that much what kind of anesthesia the anesthesiologist wants, so long as you don't move during the operation.
May 2005: Torn PCL, misdiagnosed as chondromalacia
April 2010: pain worse, lots of instability
Nov. 23, 2010: PCL reconstruction
progress here: http://pclrecovery.blogspot.com/

Offline mountainknees

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Re: Do they do epidurals in the US for knee surgery?
« Reply #2 on: March 26, 2011, 02:53:24 PM »
After eleven knee surgeries in the U.S., what I have found, and this is only one person responding,  that when I had arthroscopic surgery I did not get a spinal or epidural anesthesia.  However four of my surgeries and number 12 that is scheduled for April did require a spinal along with a general anesthesia.  I was told by my surgeon that the outcome of major knee surgery is usually less painful over the first day or two with a spinal.  However all anesthesia is a risk and I am sure that the doctors take many things into consideration before they decide on the type of anesthesia they use.  However even with a spinal I was always asleep during the major surgeries, and that is the way I want it to be.  So a quick answer would be I have had no spinals for arthroscopic knee surgery and spinals always when it was major open knee surgery, but of course check with the doctor you are going to use.  It also depends on your overall health as some people with asmatha, or heart disease do not do well with deep general anesthesia and the doctors tend to rely more on spinal anesthesia if possible but there are so many issues it is different with every patient. Good luck

Offline soozles

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Re: Do they do epidurals in the US for knee surgery?
« Reply #3 on: March 27, 2011, 05:57:33 AM »
My surgery was arthroscopic, and done with a spinal. I think the trend in surgery is heading towards the avoidance of general anesthesia if possible, people recover faster without the use of general anesthesia and it's safer for the patient to be breathing on their own than completely under. I know there are a couple anesthesia programs in my area that send their residents to the hospital where I did my surgery, because there are so many spinals and regional nerve blocks going on at the hospital (it's all ortho), that the anesthesia residents get a lot of practice in those techniques. The spinal wears off pretty quickly after the surgery, so I'm not sure how it would help with pain control. With the spinal, they put a little catheter into the spinal cord, and they run medication through that. Once the case is done, they pull the catheter out, and the spinal wears off. Guess it just depends on what they do at the center where you have your surgery.
May 2005: Torn PCL, misdiagnosed as chondromalacia
April 2010: pain worse, lots of instability
Nov. 23, 2010: PCL reconstruction
progress here: http://pclrecovery.blogspot.com/

Offline Clarkey

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Re: Do they do epidurals in the US for knee surgery?
« Reply #4 on: March 27, 2011, 02:34:22 PM »
I have had general anesthesia 3 times so far in my life, twice at the dentist when I was a kid for tooth extraction and had a face mask over my face which was not a pleasant experience and was always worried about having general anesthesia in the future again. When I had my knee surgery in November 2009 I was only given one option and had to have general anesthesia and was dreading the day of my surgery incase they put a mask over my face to go to sleep.

They told me they do it with an injection into the hand and the mask they put over your face is oxygen. I asked them not to put the mask over my face until I was knocked out and did what I asked for. I found falling into a sleep a pleasant experience and would not be afraid of another general anesthesia in the future as it not as bad as it was when they used gas at the dentist. If I had the option would have a spinal rather then a GA if the surgery is a minor procedure as it did make me feel a little unwell for a few days and the side effects are easier to recover from from a epidural.

I live in the UK and the NHS did not give me an option and told me I would be having a general anesthesia on the day of surgery and think if you are fit and healthy prefer to give a GA.

Nick  :) {2011} :)
RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline soozles

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Re: Do they do epidurals in the US for knee surgery?
« Reply #5 on: March 27, 2011, 05:27:41 PM »
clarkey, the reason you probably had the mask first as a kid is because with kids, it's hard to put in an IV before they're asleep. When I did peds surgery, and kid under age 10 or so who needed general anesthesia would get the mask first, and once they were under, would get the IV placed. Kids have little veins so it usually takes a few times to get an IV in, and it's a million times easier to do it when they're asleep as opposed to when they're kicking and screaming. Granted, the mask can be traumatic, but they're out in a few seconds, but having someone stick the kid 10 times with a needle while their arms are being held down takes a lot longer and can be a lot more traumatic.

It's interesting with what you say in the NHS preferring to give GA. From my experiences in the US with my surgical rotations, and my own couple surgeries, they try to use a sedation with a regional or local block for ambulatory surgeries and shorter procedures, and reserve the GA for long, complex operations. Granted, some of it also has to do with the patient's health too. The really sick patients, they won't even give them sedation if they need surgery, just a spinal sometimes, and the patient is awake the entire time. It probably also has a lot to do with the experience of the anesthesiologist and the culture at the hospital you're getting the surgery done. Granted, that's just what I saw when I did surgery, but it was an academic institution. And where I had my surgery done, the pre-op packet even said that more than 90% of the outpatient procedures are done with a regional block or spinal and sedation, and you can talk to the anesthesiologist to determine the level of sedation, my anes. asked if I wanted to be awake the entire time since he knew I was in medical school and he thought I might like to watch. I politely declined.
May 2005: Torn PCL, misdiagnosed as chondromalacia
April 2010: pain worse, lots of instability
Nov. 23, 2010: PCL reconstruction
progress here: http://pclrecovery.blogspot.com/

Offline Jill M

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Re: Do they do epidurals in the US for knee surgery?
« Reply #6 on: March 28, 2011, 01:13:36 AM »
I recently had a TKR and had an epidural for my anesthesia. I had my surgery at University. As many of the others have said- the anesthesia is the choice of the anesthesiologist.
I have had numerous knee scopes and I had a local nerve block along with general anesthesia.  The nerve block was for pain control post surgery. Other knee scopes I just had general anesthesia.
8/07 Right subtotal meniscectomy
4/08 Chronic meniscus tear, grade 4 changes
10/08- R distal femoral osteotomy, lateral meniscal transplant, tibia microfracture, osteochondral allograft femur
12/08- AF noted, LOA
2/09- MUA
8/09- extensive LOA, patella baja
1/20/11- TKR

Offline Clarkey

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Re: Do they do epidurals in the US for knee surgery?
« Reply #7 on: March 29, 2011, 07:20:51 PM »
Hi soozles,

You are right about kids are better of having a mask over their face then trying to put an IV into their hand if they cannot keep still. I was going to have a mask to put me to sleep again at the dentist for the 3rd time but told them I would rather they numb my mouth when I was about 9 or 10 and kept still when giving the injection. Its not a nice thing to go through at the time but was the best way at the time and will never happen again as I am happy to be put to sleep through an IV as they did when they did my knee surgery if It ever happened again!

I think some NHS Hospitals give you the option to have a GA or a spinal and also depends what the OS and anesthetist feel best with. Some prefer you to be asleep the whole time during surgery while others are happy for you to be awake. They even let the patient listen to music and watch a DVD to put their minds off the surgery.

Nick :) {2011} :)

RK: PFPS, Arthrofibrosis, Tendinopathy, Five cortisone injections
16/01/18 Anterior interval release, distal patella excision, lateral meniscal repair
18/07/14 Anterior interval release  
16/11/09 Medial plica excision, fat pad trimming

Offline amoler

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Re: Do they do epidurals in the US for knee surgery?
« Reply #8 on: April 03, 2011, 05:16:17 PM »
I had an epidural for my knee arthroscopy 20 yrs. Worst experience of my entire life. More pain than giving birth (which I've done twice without meds) Hurt so bad I couldn't scream. Screwed up my hearing for days. Had nearly a decade of nightmares from the event. Never ever again.
'77- Rt knee menicus tear
'90 -2nd menscus tear
'91 -failed arthroscopy/partial menisectomy
patella dislocation 10/ 2010
Dx = grade 4 chondromalacia + synovitis + Meniscus tear + lax strained medial ligaments
Fall down the stairs 7/20/11 - mcl sprain + 2 meniscus tears

Offline dm

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Re: Do they do epidurals in the US for knee surgery?
« Reply #9 on: April 03, 2011, 07:18:50 PM »
whether or not they do epidurals or nerve blocks depends a lot on the surgeon and the facility. Sometimes I think it's a convenience factor more than anything else, as with the general, there's less intensive patient monitoring required, as I understand it, for anesthetic level, patient sedation etc. Not to mention, some surgeons don't want the patient awake enough to ask questions etc, as they feel it interferes with their ability to concentrate on the procedure, where others don't mind.

I think the final determinant is the patient's ability to handle general anesthetic, and the staff's ability to handle adverse reactions, etc. I'm a puker, and if they're not prepared to deal with the fact that certain types of ga will make me puke coming to, then they're better off not putting me out to avoid the aspiration risk when coming to. I have the habit of telling everyone under the sun I see when having a procedure that I'm a puker, so that they make darned sure to medicate me, and medicate me again, so I don't puke, and it's worked well so far at killing that side effect. One anesthesiologist gave me 3 anti-emetics to make darned sure I didn't barf... or be nauseated at all, then or at home later.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline rode1981

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Re: Do they do epidurals in the US for knee surgery?
« Reply #10 on: April 04, 2011, 09:57:21 PM »
I am being given the option of spinal,nerve block or general for my hardware removal. I am opting for general because of a hx of migraines and honestly, I don't want to have the numb feeling.
Date of Accident 9/5/2010
Extenal Fixator: 9/7/2010
Open Reduction: 9/14/2010, External Fixator removed, Leg placed in a Bledsoe Brace
Hospital/Rehab Discharge:  10/4/2010
Dx: Tibial Plateau Fx with Meniscal Repair, PCL
NWB: 3 months
Home OT and PT for first month
Starting private PT 12/1/201

Offline debellafunk

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Re: Do they do epidurals in the US for knee surgery?
« Reply #11 on: April 06, 2011, 05:42:46 PM »
I live in WA state east side and was given the option but I chose general as if I had a epidural or spinal block I was going to be sadated also so that you are not aware of what is going on and not asking questions.  For me that was the answer for my choice of general plus it is a lot easier on the wallet.

Offline kris_83

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Re: Do they do epidurals in the US for knee surgery?
« Reply #12 on: April 08, 2011, 11:14:12 AM »
I had a general, mostly because my surgery was late in the day and I was told I would not be released until a spinal wore off enough for me to get up on my own.

I had a sore throat and hiccups for a couple of days after, as well as some nausea, but no vomiting or other ill effects. I would go for the GA again in a heartbeat. Not sure if the spinal offers extra pain control, but I was pretty drugged the day of and after surgery anyway.
12/09 dx- patellar subluxation (not!)
1/10 mri- neg; PT rx failed
4/10 more PT
5/10 dx patellar hypertension
6/7/10 chrondroplasty, patellar decompression, synovectomy and plica excision
5/6/11 dx RA, sjogren's