It is a trope in some fiction or cinema that an excruciatingly painful medical procedure has to be done on a gritty war hero without anesthesia. I recall a fictional story about a Civil War soldier who had to have his leg amputated without painkillers (admittedly, anesthesia was a hard thing to come by in the 1800s anyway), and in Black Hawk Down, there is a scene where a hemorrhaging soldier must go through some painful medical procedure to seal off the artery without morphine - because morphine would lower his blood pressure too much. (Yes, I know - morphine isn’t, strictly speaking, a surgical anesthetic.)
In what real-life medical scenarios does surgery have to be done without anesthesia?
I am not referring to situations where anesthesia is unavailable, but rather, where anesthetics are readily available but the medical situation cannot allow for it to be used (i.e., the lowering-blood-pressure-too-much scenario in Black Hawk Down). I am not referring to moderately painful procedures that can be endured without anesthesia, but rather, operations that would be excruciatingly painful. I am not referring to opting for local instead of general - I mean the complete absence of *any *anesthesia.
Off the top of my head, I can’t think of something where an extremely painful medical procedure must be done now AND the anesthesiologist can’t figure out some way to deal with it. Having said that, I have a friend that was just this side of black out drunk when he got into a bad enough fight that resulted in him getting a bunch of teeth knocked out and/or pushed up into his head. When he got to the ER, they refused him any kind of pain meds for fear of killing him because of all the alcohol in his system.
I suppose you could be in a situation like that. Intoxicated on alcohol, opiates, benzos or some other downer that the anesthesiologist worries about putting you under and not being able to wake you back up successfully. But ISTM in this day and age there would be some kind of workaround for it in a dire emergency. Either different drugs they can use for situations like this or finding another way to keep you alive for a few hours until the drugs in your system flush themselves out enough that they can knock you out.
But even in that case, it seems like they could find a way to use a local agent, nerve or spinal block…if they had to.
Also, FTR morphine is one of the drugs I’ve had used on me for Twilight Sedation when I’ve had endoscopes (along with benadryl and Versed IIRC). I’m not sure if it was used for pain or just because it knocks you out in a hurry.
That scene in Black Hawk Down was painful to watch. Even more so to know that it a really happened.
Tracheotomies are routinely done without anaesthesia due to the time factor - if you need a trach’, it’s because you’re at the risk of choking to death within minutes, and they’re often done on the spot long before the patient is in a hospital.
I wouldn’t expect them to be excruciatingly painful however, it’s just a quick snip. I never got one though, so I wouldn’t know.
Another thought that popped up : baby deliveries. Sometimes pregnancy complications (or just the time factor) prevent the possibility of an epidural or local anaesthesia, and in any event you want both mother and child awake throughout.
Did you know shit often plain *rips *down there when delivering ? So, yeah.
Childbirth is still sometimes done without anesthesia.
Pain control can be poor if opiates aren’t effective.
Brain surgery is (was?) sometimes done with only skin anesthesia. Same for eye surgery. My knee surgery was going to be done with just a block – until I rased my head to have a look :).
And of course
I had three of my four kids without any pain relief. (One induced, the other two not)
Yes, I am WonderWoman, all bow down before me! 
Childbirth is still frequently done without pain relief. In developed countries it’s often because the mother chooses ‘natural’ birth for all kinds of reasons. In less developed countries, babies tend not to be born in hospitals.
I don’t have a cite but the perception is that in America, childbirth tends to be treated as a medical condition.The trend in the UK at least, is towards home births. (Although that does nor preclude pain relief).
FYI - There are many different types of anesthesia, general, local, blocking, etc.
The only part in natural childbirth that could be considered “surgery” is episotomies, which are still performed. Those could be done without anesthesia (as may be the stitching after a tear). Other than that, childbirth should not qualify for purposes of the OP, as it is not surgical.
All three of my kids were born without pain relief, didn’t really need it at all, it helps a lot that I was the father …
okay okay … bowing down … you are a goddess … foot rubs for the rest of your life …
I’ve had at least 12 crowns put on my teeth without using anything, does that count? By the way not really painful at all.
Then it’s not exactly an excruciatingly painful medical procedure.
IIRC, brain surgery is done with minimal, if any, anesthetic, but there’s really no pain receptors to trigger once you get past the scalp.
I’m surprised they didn’t give him ketamine or something like it. Can someone say if that would have been a good/bad idea and why?
They do knock out the person the vast majority of the time though, no?
Not sure - for quite a few types of brain surgery, the result is better if the patient is awake.
As specified in the OP:
I had an angioplasty without local nor general anesthesia, but groggy with sedatives. I could hear my doctor grunting with the effort of shoving the stent through my heart and into the artery, and once he had to ask me to shift my posture. He told me the heart has no pain receptors. I think he probably did a local at the spot in my thigh where he entered the initial probe.
I had a cardiac catheterization (didn’t fix anything, just diagnostic with contrast) and the doctor did use a local anesthetic before cutting down to the the artery in my leg and opening it. Manipulating the catheter and injecting the contrast was painless. Unfortunately, the anesthesia either wore off or it just doesn’t affect the artery itself, because *closing *the artery afterward (collagen patch plus pressure) hurt like hell.
I’ve heard of c-sections being done as a crash procedure to the point where they didn’t give anesthesia, or even sedation, beforehand. :eek: We’re talking “this baby has to be out NOW or both of you will die” crash.
One of the survivors of the Oklahoma City bombing had to have her leg amputated to get her out. Because they couldn’t give her general anesthesia, they used ketamine and diazepam, which are calming and amnesic agents, and did it right there. The surgeon and paramedics said she felt everything (and screamed accordingly) but afterwards, she didn’t remember anything.
In the middle of the 20th century, “twilight sleep” was a popular obstetric “anesthetic”, and they too were given amnesic agents without true pain relief. It was discontinued mainly because it produced dopey babies and hallucinating mothers; the drugs varied but usually involved some combination of scopolamine, Seconal, chloral hydrate, paraldehyde, etc.