Different forms of anaesthetic.
 

This is a bit of a long shot, but I know some of you are in the medical profession and others maybe able to offer advice.


Spinal, epidural or general anaesthetic?

I am having the first of two Knee surgeries next Thursday to reconstruct ligaments with some biodegradable screws. If they offer a choice of all three anaesthetics there must be varying degrees of benefits. I cant find any conclusive evidence to favour any of them.


I had two phone calls from the hospital yesterday, one from the surgeons assistant and the other from a nurse in the acute care unit explaining what will happen. I really, really DON'T want to stay in, but the nurse seemed fairly adamant that I will be staying for pain management, but said they will discuss this with me after the surgery. Also mentioned something about I will need physio that day, if not the morning of the next.


So if I opted for the spinal or epidural, will this mean I have a better chance of being let out that day?

Has anyone had the spinal or epidural form of anaesthetic ? are you relaxed ? what happens if you panic, do they knock you out?

Is everyone sick with a general anaesthetic? The prospect of barfing everywhere fills me with dread too.:unsure:

Re: Different forms of anaesthetic.
 

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Re: Different forms of anaesthetic.
 

layperson opinion alert:

I had knee surgery under general (nothing near the extent of yours), but went home the same day. I think you staying in overnight would be more to do with the extent of the surgery, not the type of anaesthetic.

I wasn't sick or nauseous, but I think they can give you anti-nausea drugs if you feel iffy.

Hubby's dad had an epidural for a hip replacement (he's 82). I think he said he could here them chiselling away, but they had him dosed up with something so he didn't really care what was going on.

Good luck. Are they expecting you to recover enough to be able to ski after you recover?

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My only experience of anaesthetic is from 2 schedule C-sections when he stuck a big needle in my back (I assume that's a spinal:unsure:) and I could feel nothing from the shoulders down. I was up an about that night with the aid of morphine.:eek: (Hopefully someone else will share a more relevant experience.)

Re: Different forms of anaesthetic.
 

I'm just waiting for someone to suggest homeopathic anaesthesia or perhaps aromatherapy...

Re: Different forms of anaesthetic.
 

Why? Do you want to get this thread closed too?

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or cross your fingers and pray to the almighty COD.

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Or hypnosis....?

http://news.bbc.co.uk/1/hi/england/sussex/7355523.stm

Re: Different forms of anaesthetic.
 

back on thread......

xray person so not qualifed to talk about anaesthetics except as a patient

I would go for general if thats what they normally do. You will see the anaesthetist beforehand and you can discuss your concerns with her/him.

I have never been sick after a GA, sometimes have woken up just fine and eaten a meal, once even had some champers.

I dont fancy someone fiddling around with my back, a nice zzz then wake-up and all done. Thats the way for me.

Re: Different forms of anaesthetic.
 

I would not opt for a general but then I have had two epidurals and better the devil you know.

You are young and fit so a general probably carries low risks, but it still has some miniscule risk. But generally I think generals make you feel pants.

But not having a general means being awake whislt they operate and this is scary. You hear noises from your body, which isn't helpful and you can feel things in a strange way, rummaging round inside you. This is probably not as bad for knee ops. Hearing them counting and recounting instruments whilst they then opened me back up to restich was fairly scarey ................

I think if you want info on spinal vs epidural go to birth sites and search there.

Epidurals can be scarey and the consent form can be scarey. My second was inserted by the top consultant and it still had to be done twice. It was later topped up with spinal and not feeling your legs for quite some time is scarey, and you convince yourself you are never going to feel your legs again!!

My house is a mess and I couldn't possibly let anyone in it today!! . But if you are at home now and want to come out with me and P we are off to farmer's markets for a brief time at about 12:45 and could talk whilst I give you a lift there and back!!! and buy some nice sausages too!!!!!!

Gryph

Re: Different forms of anaesthetic.
 

Hi,

I, personally,don't like general anaesthetics as they make me feel like crap and i usually throw up.

I have had 3 spinals, 2 were for c-sections and 1 was for a "wash out" of my knee. I much prefer this. Obviously you have no feeling in your lower body for a while but you don't have that horrible groggy feeling that you get with a general.

Just a couple of things though, if you need a catheter make sure that they put it in AFTER you are numbed up and take an MP3 to listen to music if you can instead of the operating room noise. Also don't look up at the big operating lights as you may see something you'd rather not in the reflection! I'm glad I knew about that before my sections! :ohmy:

HTH and that all goes well.

Re: Different forms of anaesthetic.
 

Really agree with the mirror/lights thing!

Re: Different forms of anaesthetic.
 

I don't but, then, I've never had a C-section and nor am I likely to.

I had a minor op done on my neck years ago, under local. The surgeon set up a mirror, so I could watch.

General anaesthetic has never affected me afterwards. The last couple of operations I had could probably have been done under local. I'm not sure why they weren't. Maybe they figured I couldn't lie still for long enough while awake.

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I think it depends upon the level of gore/blood! and maybe size of incision and squeemishness!

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As for GA making you feel bad , I had the opposite . I was high when I cam around from mine. I didn't stop talking for the entire half hour I was in recovery (picture the scene from train spotting ) !!!!

When they wheeled me back to my room and I had stopped talking long enougth , Ben asked me how I felt , I said in a puzzled tone "fine , except I seem to have a bit of a headache" . He then pointed out that this was hardly suprising seeing as I'd had my sinuses drilled out !!!!!!!

Did feel a bit yucky stomach wise , not sick but didn't want to eat.

Personally though , I would go for the spinal , cause I'd want to watch and ask endless questions!!!!

Re: Different forms of anaesthetic.
 

With the spinal or epidural they usually give you enough relaxant (sp?) that you'll likely sleep through it anyway. When my O/H had his broken hip and femur fixed, he snored through the whole thing, with a spinal. If you prefer a GA, the anaesthetist usually gives you stuff that stops the barfing before it starts. Good luck.

Re: Different forms of anaesthetic.
 

Had an epidural for childbirth. You won't feel a thing and no you will not be released the same day. The spinal and epidural require that you can take a piss after it has worn off to be sure that your kidney/bladder is back to full function. So you will be confined to the hospital.

I had a local for breast cancer removal and left the same day.

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I just ask myself why do they do GAs as routine if an epidural is better/safer??

Anaesthetic risks, dodgy heart and lungs, want the mum to be awake when the babe is born?? Ok then keep em awake.

I dont want to listen to machine sounds and drilling, especially if it was my bones they were drilling. The dentist is bad enough.

Re: Different forms of anaesthetic.
 

Just was talking to a friend (nurse) in my office here at Calgary. Her son-in-law had reconstructive surgery on his knee just recently and came home that evening from the Peter Lougheed Hosp.

As soon as you regain feeling in your legs (after a spinal) and prove that you can P you can go! :thumbup:

Re: Different forms of anaesthetic.
 

Hi Smelly

GA...nowadays the drugs used in GA's are much better than they used to be....a GA involves several drugs injected intravenously, the drugs include muscle relaxants and pain killers. 10 years ago GA's were notorious for causing sickness but today the drugs have changed and the level of sickness and nausea is greatly reduced....if you do feel sick tell your Nurse and she can give you anti sickness drugs. The advantage of GA is as mentioned you are unaware of the events in theatre which can seem and sound horrific (even as a nurse they can be). Your discharge timing will depend upon the drugs given, the surgery and your side effects also in the UK if you have a GA the NHS generally doesnt discharge you same day if you live alone.

Spinals/Epidurals... They do indeed speed up discharge times....once we can ascertain you have bladder control (you have pee'd) and you have full sensation in your legs providing everything else is okay you should be able to go home. We do this to ensure you have recieved no spinal nerve damage. Downside is as mentioned you are aware of everything going on in theatres. Orthopaedic Surgery often has more sedative drugs with the spinal/epidural due to the smell and sounds in Ortho theatres and the time of the surgery involved.

Your Dr will make an assessment of your Anaesthetic risk....you shouldn't be a GA risk unless you have underlying disease that mainly affects your Cardiovascular Function or Respiratory Function.

In my experience, for me....I would always opt for a GA unless minor surgery....just my opinion

Good luck

Julie

Re: Different forms of anaesthetic.
 

bazzz try suicide, you`ll cure so much hurt, upset, and stress

Re: Different forms of anaesthetic.
 

I had a general a couple of years ago. It's brill. Sudden drop to sleep and wake up with several hours missing. Felt perfectly fine. Most modern generals are pretty good with few side effects, and even then they only affect a few people. I was perfectly fine a minute or two after waking.

The decision you need to start with is do you want to be conscious during the op or not? If you don't want to be conscious (would definitely be my choice) then go for the general. If you have some strange fascination with wanting to hear what they are doing to you then go with one of the other two, though it seems like my worst nightmares.

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Mrs Blimey (doctor) writing:

spinal and epidural are the same thing, "spinal" being the lay-term.

any anaesthetic injected directly into the spinal cord (which is not what happens in an epidural - it goes into the fluid surrounding the cord) would be a form of local anaesthesia and wouldn't be what you would receive for a knee operation (local would be your knee in this case, obviously).

you can have day surgery with either epidural or GA - it's not the type of anaesthetic but the type of surgery, other medical comorbidities you have and your response to the procedure etc that determines the length of stay, otherwise the anesthetists office would be advising you on this, not the surgeon's office as in your case.

hope that helps.

Re: Different forms of anaesthetic.
 

how old are you?

Re: Different forms of anaesthetic.
 

...... something you should never ask a lady! :mad:

Re: Different forms of anaesthetic.
 

Hi Mrs Blimey (doctor)

Our hip and knee replacement patients are routinely offered spinal anesthesia as opposed to GA, unless they have a strong preference or other medical considerations eg previous spinal surgery. I see no reason to say that Smelly's reconstructive surgery would not be done under regional anesthesia.

GA's have a demonstrably higher risk of morbidity/mortality, http://www.pubmedcentral.nih.gov/art...rtype=abstract and regional spinal/epidural block can lead to better post-op pain relief than GA's followed by PCA, and a faster recovery time.

I'd opt for a spinal personally Mels, given the choice, and if the thought of "hearing/feeling stuff" upsets you, you are usually offered sedation and can listen to music etc so you are unlikely to have much recollection after the event. :thumbup:

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Smelly,

Here's a link to the "Knee Guru" site which has some nice info on ACL tears, reconstruction and rehab..... http://www.kneeguru.co.uk/KNEEnotes/node/775 :thumbup:

Re: Different forms of anaesthetic.
 

Many thanks for the offer Gryph, unfortunately I was at work yesturday. I hope you enjoyed those suasages though :thumbup:


I did have a surgery at the base of my spine, just over 15 years ago I wonder if this still counts.


Thanks Morw :thumbsup: The Knee Guru website is a great resource and I have been posting a little on the bulletin board.

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I've had a number of reconstructive surgeries on my skull and eventually gave up on the anaesthetics altogether. The anaethetics became an anathema to me, and the saw-bones all proffered the various drugs as panaceas for my "head troubles." I eventually opted for a technique called the stick (q.v. photo).

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Thanks for all the other replies too. It seems people have a real mixture of preferences when it comes to anaesthetics .

I guess I will have to see how I feel on the day. I think I might have a few things to consider and chat with the anesthetist about. My mother had DVT from a knee trauma and subsequent surgeries, not sure if that is also a factor to consider. I am guessing this will all be discussed and assessed on the day.

The last time I had a general anaesthetic was a very long time ago and I dont have any recollection of how I felt after the event, as it was an emergency op. in the middle of the night. It does sound like things have moved on in the last 15 years though.

Thanks again all.

I am looking forward to getting the surgeries all over and done with.

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:thumbsup: Yeah, so your finally having it done, it has come round fast.....

OH has just said you need to go for a nice sleep when your having it done, you know speaking from experience and all. ;)

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I had a general for a NHS day surgery a couple or so years ago. I requested day surgery to reduce the infection risk and my surgeon was fine with that. I was pretty nervous beforehand (maybe I'm just a control freak?) but I was fine, if a little "feisty" (according to the staff) as I came round. I had no real nausea but did feel a bit pissed for a couple of days. I was surprised how long that feeling hung around as I'd been told I only had to have somebody around at home for 24 hours but it could have been the mega painkillers I was on. No hangover mind :thumbsup:

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Well I'll not wish you good luck cos you are in the very best of hands. See you afterwards! :thumbup:

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I know you're the doctor so I'm probably remembering wrongly (it's been a good few years!) but I've had 2 c-sections under spinal block and was told by the consultant (the second time around, when it was an elective section and I had time to care!) that a spinal is injected directly into cerebrospinal fluid sac, and acts rapidly, whereas epidurals are injected into the space outside the sac (epidural space) and take a while (20 mins?) to work. He also said that the spinal is administered once, acts rapidly, and lasts for up to a couple of hours - whereas the epidural is usually left in place and can be topped up.

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I've had spinals twice. Can't remember how I felt the first time (was administered after 18 hours of established labour and I'd gone through a couple of canisters of "gas and air" by that point :rofl:) but second time around, for an elective section, I remember feeling very calm... I've no idea whether this was due to the anaesthetic. I do recall that my BP plummeted, though, which was a known side effect of the spinal. I also had a complication for several weeks afterwards that couldn't be pinned down specifically to having the spinal, or nerve damage that occurred during the c-section, but it eventually rectified itself and I'd still rather opt to be conscious for an op., if at all possible.

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No, your memory's fine! :thumbup: ;)

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Poff
Thanks! I tend to remember that sort of thing word for word, and yet really struggle if someone unexpectedly asks me my phone number, LOL!

On a totally different thread - maybe we should try to arrange a BE meet at Horseshoe Canyon with Piff Poff in the next few months? Sounds like there's a few of us who want to explore.

Alex

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A former co-worker of mine requested to have a mirror available so he could watch his groinal hernia operation. A couple of years later I was at the same place (Shouldice in Richmond Hill) and a mirror was the last thing I wanted to have available.

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I think this is a fair point....I had a wonderful spinal for an elective C-section and felt completely numb from shoulders down and was therefore quite relaxed....no other sedation given to me but obviously cutting you open to lift a baby out doesn't actually involve any scary mechanical noises, so having had good GA experiences for other things, personally I'd go GA for involved knee surgery...being awake in an operating theatre is much less scary when a beautiful baby is likely the end result.

I'm fine with dentistry with just local anaesthesia (apart from impacted wisdom teeth) but I just wouldn't fancy a power tool on any other body parts while awake...I think it's because your teeth can more easily removed and therefore are not strictly part of your body in the same way.

From my experience I would also say spinal is way better than epidural for effective numbness...with epidural you can still feel tugging ....with a properly given spinal...you feel nothing whatsoever....completely numb. The needle going in did not hurt at all - they gave me a pinprick of local first.

Best of luck whatever your decision - lets face it modern anaesthesia is so good, you'd be pretty unlucky to have a bad experience with any of the methods.

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I have had both and agree they are different...spinal much better for relaxed C-section as I said above.