Amputation without anesthesia?

On disaster movies sometimes we see people getting limbs stuck on places like buildings, rocks, derbies, etc etc etc, and the person ends up having to amputate the limb. Would it be possible to survive the humongous pain involved in an amputation? Of course, the guy from 127 hours did it and survived, but… is it common practice not to use anesthesia on an emergency amputation?

In pre-anaesthesia days, doctors had techniques to carry out emergency amputations as quickly as possible - less than a minute. This was just as terrible as it sounds, and some patients declined the surgery, preferring death to the pain.

Anesthesia is for wusses. Real men bite on something. That has lots of splinters.

I’d like to see a cite for that.

10 minutes to amputate a limb is doing really well, and it’s what Civil War “operators” (or “sawbones”) aimed for. They also, contrary to Hollywood portrayal, used chloroform as an anesthetic most of the time. I’m sure they sometimes ran out, but those were exceptions, not the rule of the day. Search | eHISTORY

Before chloroform, they used poppy infused wine or tincture of opium (laudanum). That’s been around since at least the Ancient Sumerians. Ancient Egyptians probably used mandrake extract (we know they did amputations.) The Ancient Chinese used cannabis and aconitum (wolfsbane). Pretty much everyone used alcohol, as well. And by everyone, I mean the surgeons, as well as the patients. :wink:

Can you survive an amputation without anesthetic? Yes. Was it ever routinely done, even if an anesthetic was available? No. But you were more likely to die of blood loss or subsequent infection than the pain. Pain may make you pass out (merciful relief, if you ask me) but it won’t kill you.

That and a lot of people would try to get drunk before hand.

Fairly easy. The great Scottish Liston’s time for cutting off a leg was 2.5 minutes; but sometimes 28 seconds per limb.
However he was a bit slapdash, and contrary to usual student practice, observing assistants would have been better advised to watch from a mile away.

Yes, amputation was done very commonly before anaesthetics were invented - indeed, it was by far the most common form of surgery, simply because it could be accomplished fairly quickly and did not call for great precision (or even all that much anatomical knowledge). The patent would often be made drunk, as a sort of (not very effective) anesthetic.

It was a standard, required part of the medical curriculum at Edinburgh University medical school in the early 19th century (probably at other medical schools too, but Edinburgh was the best at the time) for students to be witness to an operation. As a student there, the young Charles Darwin witnessed the amputation (without anaesthesia, of course) of the limb of a young child, and found the experience so distressing that he dropped his medical studies altogether (much to his doctor father’s displeasure).

That was Aron Ralston in Horseshoe Valley, Utah. If I were in that position I’d rather just pass out and die. Or slit my throat.

Yes, a ‘bit’ slapdash.

While I’ve never personally been present for an amputation in the field without anesthesia (I’m an EMT), I know of at least two that have happened in my area. One was when a gentleman got his leg caught in a wine press while he was cleaning it (I confess I’m not familiar with the safety regulations concerning this piece of equipment, though I assume they weren’t followed properly). He ended up having his leg taken off roughly mid-shin.

As I said, I wasn’t there, so I’m not sure why there was no painkiller administered (could have been an allergy to morphine or something similar). But the paramedic that performed the procedure is one that I’ve worked with and known for several years, and I trust his word on it.

It’s my understanding that while amputation may seem much more dramatic than other surgical procedures, it isn’t proportionally more painful–after all, the amputated limb is quickly gone. That doesn’t mean it wasn’t horrifically painful, but not a whole different category than a mastectomyor appendectomy.

I disagree that amoutation is no more painfull than a soft tissue surgery. Bone pain is worst than any other pain.

It happens that limbs get severed in accidents pretty often. Those people often don’t even know their limb is gone.

BTW, the reason people who have field amputaions survived is a with complete ampitation, whether traumatic or surgical, as the vessels are cut they snap back into the tissue.
There is much more bleeding from a partially severed limb, because the vessels are held open.

I recall the testimony from a fellow whose hand was amputated for theft in central Africa (south Sudan?). They twisted a wire around the wrist and there was an incredible burning sensation, then he passed out. I don’t think you die from pain. You just wish you would.

Yes, in the pre-anesthesia days, assuming there was any attempt at all to deal with the resulting massive bleeding, people routinely survived the pain of amputation. What they died of was usually infection in the wound after the amputation, days or weeks later.

People can survive horrific amounts of pain, whether they want to do so or not.

http://www.napoleonicwarsforum.com/viewtopic.php?f=22&t=443

“Baron Dominique-Jean Larrey, arguably the man behind modern surgery, stressed the best way to amputate was immediatly after the soldier was wounded. He said and was correct that, while the man’s body was still numb from shock, you could amputate with ease. This is because when the brain is in shock the muscles relax, and there is lower blood pressure. Thus making it easier to cut through the flesh with less pain and blood. So great of a surgeon was Larrey that he could amputate an arm in 17 seconds, and an leg in one minute. All with a low mortality rate. There is no question why the French soldiers and even the enemy adored and respected him.”

By the way, people survive amputations without anesthesia all the time, today. Accidents that remove body parts are amputations. I have a friend who survived a leg amputation through the thigh. The only surgical instrument used was a train. Of course, they did use other instruments in a second procedure not long after…

Anyone remember the story about the woman whose leg was trapped in the Oklahoma City bombing, and a surgeon went in there and amputated her leg to get her out? I wondered what they used, and it turned out to be ketamine and diazepam, which is used a lot by veterinarians and some battlefield surgeons use it too. Apparently the person still feels everything, but remembers nothing afterwards. This woman said she didn’t remember anything from a few seconds after the injection was given, to the time she woke up in the recovery room in the hospital.

The surgeon also said he hoped he never had to do anything like that ever again. :frowning:

In the pre-anesthetic era, people were sometimes given a shot of whiskey (the bottle was often shared with the doctor) and the limb was sometimes packed in ice or snow if those were available.

Ketamine is a dissociative, so it’s possible that while the subject felt a great deal of pain, they may not have perceived it as pain. The brain is, after all, a wacky place.

In grade school I read a book about the Doolittle raid called 30 Seconds Over Tokyo, by Ted Lawson. Lawson’s leg was mangled when he crash landed his B-26 in China after the raid, and the crew’s flight surgeon had to amputate it with little pain killer, a scalpel, and a crosscut carpenter’s saw. Lt. Lawson said he kept having to tell his friend to slow down while sawing the bone because the heat from the friction of cutting was too much to stand. Impressed the hell out of my 10 year old brain…

Wasn’t the 127 Hours guy’s arm basically dead (and thus pretty numb) anyway?

Rather than take 10 minutes to saw through a limb, wouldn’t it be better to use a really sharp ax and take a split second?

Splinters.