Epidural vs. general anesthesia - possibly TMI

In My Humble Opinion
1

So I am scheduled for total hip replacement (THR) on June 20th. The procedure is approximately 2 hours long, and involves removing my femoral head and pounding a metal rod into my bone, among other loud and violent things. My doctor has recommended epidural anesthesia with IV sedation, instead of general anesthesia. He says my recovery will be so much easier, particularly the first few days. As a nurse, I know that general anesthesia stays in your body and is hard to get rid of, without a lot of forced deep breathing exercises. My only experience with general anesthesia was for a laparoscopic gall bladder removal, which was probably a 40 min. procedure at longest. I had no side effects, in fact I slept very well that night for the first time in years, and woke up without grogginess or nausea. I have never had an epidural, but hear that the side effects may include a headache and mild nausea.

With an epidural and IV sedation, I am afraid that I will hear things that I don’t want to hear. I realize that most likely I won’t remember things afterwards, but during the procedure I would freak out if I heard a bone saw revving up. There seems to be many pros and cons for both types of anesthesia.

Not looking for medical advice, but I think it’s OK to ask about other people’s experiences, right? If not, then I guess this thread will be locked by a mod. Thanks for help, info, etc.

2

I’ve had both an epidural and IV sedation, but not at the same time. I had the epi for labor, and IV sedation for dentistry, carpal tunnel surgery, and invasive eye surgery to repair a torn retina.

I remember only snippets of the eye surgery, and nothing about the other ones.

IV sedation knocks you out, effectively. And it isn’t too abd to wake up from, though you will likely be drowsy for a few hours afterwards.

I’d go that route over general, IMHO.

Epidurals can cause headaches if there is spinal fluid leakage, and it is uncommon. Some people get sick from the narcotics. Neither happened to me.

3

There can be no spinal fluid leakage with an epidural. An epidural goes only into the epidural space, not the spinal cord.

4

Had a pilonidal cyst removed two years ago, and opted for general anesthesia. They offered me the epidural with sedatives, and I thought about being conscious, even just for a few moments, in an OR while my ass is in the air and they are cauterizing an ice-scream-scoop-sized hole with a blow-torch.

What if I could smell it…?

Yeah. I opted for the general. The only reason I disliked it was b/c of the breathing tubes they shove down your throat; they busted my lip in the process and my throat felt like somebody had run a rosebush through it for a couple of days…but other than that, no big deal. I’d do it again today. Never had an epidural, so I don’t have an opposing argument, but the general was fine and I see no reason to watch somebody stick the world’s longest needle into my back just so that I can stay awake while people are slicing me open.

5

You might ask for what is called “conscious sedation.” It is safer and easier to recover from than general anaesthesia. With the right choice of drug, you will be conscious but sedated during the procedure, able to respond to commands and questions. But you will have no memory whatsoever of the event. If your main concern is that you might hear, smell, or sense something unpleasant, maybe conscious sedation is the way to go.

6

The only surgery I ever had was under a local anesthetic. It wasn’t nearly as major as hip surgery - it was draining an abcess on my face.

I was alert throughout the procedure and yes, I did hear, smell, and otherwise experience the surgery - the only thing lacking was pain. My memory of the episode was quite clear. The crucial thing: you need good anesthesia done well. The sounds/smells didn’t bother me much, but that’s me. I could certainly see someone else getting the gibbers over that.

In fact, my experience with non-general anesthesia went so well that’s I’d probably opt to be awake for any other surgery I may have in the future, assuming that’s an option. But like I said, that’s me, and it was a relatively minor procedure.

7

I’ve had just an epidural (for a cesarean), epidural with that “twighlight sedation” stuff (for appendicitis) and a full general for a bloody, horrible, smash and grab cesarean.)

Of the three I’d say the epidural and sedation was the least horrible.

The just epidural was scary because I was crystal conscious and I really didn’t like the fairly rough pulling and dragging that went on to get the baby out. On the other hand I was fully awake to enjoy him just a few minutes later.

The epidural and sedation was interesting - I was very frightened getting the epidural. They told me I had to be completely awake for that bit so you cooperate with keeping still. I kept VERY, VERY still, sweating with tears pouring out of my eyes, waiting for the pain. Then he said, “there, it’s in!” Hardly a prick, just an odd wiggly sensation of the tube being inserted and taped down. Then they ran in the sedation and I felt like they could do anything they liked, I didn’t care! I actually do have one memory of the operation. The dr took out my appendix and commented on how very long it was. He said “I didn’t know foreigners had such long ones” and I very acidly replied “Well, how many foreign appendixes have you seen? Just mine! That’s the sort of ignorant and racist comment that you hope doctors won’t make.” The other doctors were in hysterics, and egging him on to apologise to me, which he did, dangling the appendix over my face for me to look at. (He was right, it was long.) The next day I nervously asked him if it had been a dream, and he roared with laughter and told me that indeed it was not.

The general was horrible - I woke up from it fairly quickly and the pain was terrific. Nothing shifted it and I was miserable for a couple of days. (The epidural for the appendix was left in place for 24 hours so the pain was really not too bad at all.)

Good luck with what you choose. And look forward to being more mobile and pain free when it’s all over!

8

If it is just the noise you are worried about, can you wear earplugs, or better yet, listen to music?

9

I’ve had surgery under general anesthesia as well as with an epidural and sedation. My choice would be the epidural and sedation. I don’t always have problems with a general, but have had resultant nausea and vomiting, and always, always, that horrible sore throat afterward. I also like Brynda’s suggestion of earphones and music, if that might be possible.

10

Hi,

My husband is having a THR (his second one) On June 28th. The first one he had was 2 years ago and they planned on doing the epidural and not the general, but after the surgery was over the doctor informed us that they wound up giving him the general anyway because he was ‘anxious’. They gave him something to relax him (boy was he relaxed!) before bringing him to the operating room, but I guess he doesn’t take to sedation easily and I he freaked out. Everything went fine, but it did take him longer to be able to get up again for the first time. We are going to ask for the epidural again this next time, but, if he starts yelling at the surgeons again while they are trying to operate, it is probably best they just knock him out!

In my opinion, epidurals are safer.

It’s a great surgery. Try not to worry too much. You will feel so much better almost immediately!

PS: He’s 33 and has avascular necrosis.

11

Happened to me—I had an epidural back in '86 and they punctured the spinal column. I was in the worst pain I’ve ever been in in my life for a month, had to be trussed up and hanged from the ceiling in a Trendelenburg Position while my spine healed. General anesthesia makes me throw up, but I will never have an epidural again.

By the way, congrats on the hip repleacement: a friend had that done, and he said when he woke up, it was the first time in years he had been free of pain, he felt like doing cartwheels!

12

Once again, the Dopers come through with concise, comforting information. You guys are great! I know I am gonna feel better after, it’s just getting there that worries me.

I found a cute T-shirt, says “Recovery for Dummies” on it and looks just like all those “for dummies” book covers. Maybe they’re talking about a different kind of recovery, but I thought I might look cute in it walking around with my walker.

13

I was thinking about making a tee-shirt on zazzle or somewhere with the slogan:
Totally Hip.
(Replacement)

Since you mentioned in the title, TMI, I feel I can share this bit of grossness. The first time my husband had the THR, he was wondering what they did with the original hip bone. He said he wanted to give it to our dog. Eww!

He was just kidding.

14

Mr Sqwert is a nurse working in Orthopaedic Theatres, primarily carrying out joint replacements - from teeny tiny finger joints right up to hips and knees. He says that some of the ‘old’ hip bones are sent off to the bone bank, where they are minced up and used as donor bone for grafts etc. I’m with Mr Meow - I quite like the idea of Fido chewing on one on the front porch though.

Here in the UK, most Theatre Units have headphones available so you can listen to music rather than the equipment and banter. Unless you are keen on the compilation CDs that are relentlessly given away as freebies, then I would suggest taking your own choice of music with you. Having said that, most people sleep right on through the whole thing due to the sedation. Even if you don’t sleep through, the chances are that you’d remember very little as a fair proportion of the sedatives given have a retrograde amnesiac effect.

15

This is true, but they don’t work on everyone. I’ve had conscious sedation for a procedure, and remember just about everything; also, I’ve had Versed every time I’ve had surgery (except for the last time), and it’s never had the amnesiac effect on me; I didn’t have it last time, because I told the anasthesiologist not to bother, as it has little if any effect on me.

16

I’ve had general anesthesia once (for nose surgery back in 89), and epidurals twice (for childbirth). I don’t recall having any particular trouble with the general; I’m sure I was a bit out of it but then again I was also getting Tylenol 3 for the pain for the first day. I wasn’t “up to speed” for a few days but then, with a hip replacement, you wouldn’t be anyway. I don’t know if it was because of lingering anesthesia effects, or just the trauma of the surgery.

Now, with the epidurals: Neither one worked well. The first one (vaginal delivery) left one area of my abdomen completely unanesthetized. I might as well not have bothered. They wound up redoing it at the last minute when they thought they might have to do a c-section. That one worked, but I only needed it for 10 minutes, as they managed to deliver the baby via forceps.

The second one was for a c-section. Urgent, but not a slash-and-grab one, so they had time to do it right. Unfortunately, when some of the insides were no longer inside, they found that my f*ing bladder was not numbed. Apparently this is not totally uncommon. And at that point, there wasn’t a whole lot they could do about it, not like they could roll me over and readminister it!! Fortunately, the pain was not searing, and in fact was less painful than with my first child, and it was over quickly - once the baby was out, they weren’t battering the bladder any more.

So anyway, I tend to view epidurals with a very jaded eye - they’re probably terrific if they work but you couldn’t prove it by me. I’d recommend meeting with the anesthesiologist beforehand and make sure you know what all the options are, and also what their fallback position is if they get “in” and it isn’t doing the job.

17

That’s not on my list.

Things that would freak me out to hear:

“Whoops.”

“Now, was that my right or the patient’s right?”

“What the hell is that?”

“Hammer. No, not that one. The big one. No, the big one.”

18

Hi beckwall,

First, good luck, I expect your quality of life is going to get vastly better after the operation.

I did some research on artificial hip implant surfaces that promote bony ingrowth during my undergrad, and I’ve seen a total hip replacement, as well as a knee replacement.

My advice to you is that it depends more on your character and your sensitivities.

If you’re the kind of person that wants to watch, is completely unphased by discussions of surgery, the sight of your own blood, and really don’t care about the crunch of teeth being extracted, then go for the epi. It’s true that recovery is much faster.

If you are even a bit squeamish, or anxious ,trust me, get the general, and you may want to consider stopping reading my post about here.

OK, still with me? Right then. Hip replacements are total power tool Black & Decker carpentry fests. Saws. Drills. Hammers. There will be considerable force used to manipulate your leg, which you will still perceive, not to mention the vibration and noise. There will be bone dust and biological debris being splattered by the power equipment; this is why the orthopods wear full face shields when they do this, and sometimes they should have little windshield wipers on those things. There may be the smell of burnt flesh from electro-cautery, and from the saw blade heating up a bit.

If you find any of the above disquieting, especially because it will be your body, then go for the general.

If you think it’s kinda cool, hey, go for the epi, and ask for a mirror so you can watch! :smiley:

-trupa, who is more freaked out about wisdom teeth than a big operation. Maybe it’s because the teeth are more likely to get taken out than my hip right now…

19

I’ve had epidural anaesthetic and no sedation several times for extracorporeal shockwave lithotryptsies (kidney stone blasting) and it was fine - without any pain, I didn’t mind any of the other things going on.

I’ve had sedation for several things including a bronchoscopy and biopsy, as well as your more humerous and degrading internal endoscopic examinations. Though I had spotty memories, they weren’t unpleasant.

I’ve had general anaesthetic for several surgeries, and it’s usually been a tough climb back into consciousness, but partly because the surgical wound hurt. I awoke in the OR at the end of a lithotomy (cutting for stone, namely a 13 mm and a 9 mm ureteral kidney stone) when they were moving me from the table onto a gurney, and that was very uncomfortable - plus it was a 10 day hospital stay.

I also had a hernia repair as an infant, back in the dark ages when the conventional wisdom was that babies couldn’t feel pain and no anaesthetics or sedatives were necessary. Fortunately I don’t remember this, but it’s probably the reason I am so squirrely today.

And I’ve had 3 epidural injections of stearoids into my spine this spring, without any sedation - one of these hurt so bad I had nightmares the next 3 nights.

All things considered, I think I’d opt for the sedated epi. That being said, I am fearfully contemplating what a Trendelenberg position is, and wondering if I will have another weird dream tonight.

20

I’ve had my share of surgeries from gall bladder to a kidney transplant. Do yourself a favor go with the general. You don’t want to know whats going on when they are sawing and hammering your body.