Medical situations where surgery must be done without anesthesia

[Drum_God]

In the HBO miniseries John Adams, there is a scene where Adams’ daughter has a mastectomy due to breast cancer. Each of her limbs was tied to a bedpost and she was given a piece of leather or something to bite.

That didn’t seem like fun.

[RivkahChaya]

@MLS

Yeah, my daughter’s second child was an emergency C-section of that exact type. I asked her about it weeks later and she does not remember much of anything, including pain. It seems she was too busy actually dying to be aware of anything like that. Both hers and the baby’s vital signs suddenly plummeted to about zero.

@Shmendrik

I haven’t. Crash c-sections involve the rapid induction of general anesthesia (assuming no epidural in place). Mom and baby dying is not a situation that can be solved by cutting into an awake patient. The only exception would be if the mom was already in cardiac arrest.

I was being taken into an unplanned c-section when they couldn’t get the baby out with forceps. Suddenly his heart rate plummeted. It was now an emergency, and although they had tried to restart my epidural (27-hour labor), I felt the knife go in. So the mask came down over my nose, and I was knocked out with something. Anesthesia continued through an established IV. I was out for two hours, thank gawd. Baby was born blue and had to have his breathing started. DH thought he was dead. I am so very glad I did not see any of that.

[Leo_Bloom]

@nearwildheaven

Until recent decades, some people believed that small children didn’t feel pain, or didn’t remember it if they did, and if they did, it would build character, or some similar nonsense.

:mad:

As a kid in 60s I and my brother were never given anesthesia at the dentist when they drilled for cavities.

Since then someone told me that “it just wasn’t done.”

Please tell me that kids don’t have to go through that again.
ETA: Rivkah: “DH”?

[Melbourne]

@rsat3acr

Dentist here. I have done root canals on three people without anesthetic (they don’t use anesthetic for anything). Most people would consider that a painful procedure. It wasn’t however painful for any of them. People can train themselves in pain perception.

I never had anesthetic at the dentist when young. I used a relaxation/self hypnosis technique. Until two things happened.

(1) He went in much harder and longer than planned. Soon after …

(2) I did a relaxation excercise at the begining of an exam, and woke up at the 20-minute warning bell.

Since then, relaxation techniques and self-hypnosis just make me more alert and defensive.

[Velocity]

Thanks for the responses everyone, but, again - some of these are not examples of where the surgery *had *to be done without anesthesia. Some of them are callous or lazy doctors not giving anesthesia because they couldn’t be bothered to.

[Dinna_Fash]

@Leo_Bloom

As a kid in 60s I and my brother were never given anesthesia at the dentist when they drilled for cavities.

Since then someone told me that “it just wasn’t done.”

Please tell me that kids don’t have to go through that again.
ETA: Rivkah: “DH”?

No, kids no longer have to go through that. Two of my kids had cavities at age five/six and they were treated with nitrous oxide first. I didn’t like seeing them groggy from the gas, but better than going without

Also, DH = Dear Husband

[Backcountry_Medic]

@Velocity

Thanks for the responses everyone, but, again - some of these are not examples of where the surgery *had *to be done without anesthesia. Some of them are callous or lazy doctors not giving anesthesia because they couldn’t be bothered to.

I think this scenario mostly exists as a TV/movie trope. There are a few ‘surgical’ procedures that are done routinely without any anesthesia, but often they are quick emergency lifesaving maneuvers, rather than a long ‘rooting around through a body cavity’ type of procedure. Things like needle and surgical cricothyrotomies would be incredibly painful and distressing if you had to just lay there and take it, but they are only done when the patient is likely on the verge of unconsciousness anyways. Same thing for needle decompression and chest tubes. In an emergency there sometimes isn’t enough time to dose, prepare and administer anesthesia before you have to act to save someone’s life. I have seen several grown men crying after having emergent chest tubes placed sans local or general anesthesia, but they were all tears of joy at having their lives saved in the face of imminent suffocation from a tension pneumothorax. There is nothing like slowly feeling yourself take shallower and shallower breaths until you can’t get any air at all to instantly erase the limits of your pain tolerance.

Your body knows the ABC’s of first aid better than you might imagine, and when something is severely affecting your airway, breathing or circulation almost all other concerns have the volume turned down so low they might as well not exist. I can’t remember the specifics of the BlackHawk Down scenario, but you pretty much disqualify it when you say ‘not counting when anesthesia is unavailable’. Morphine isn’t an anesthetic in standard doses and has a relative contraindication for someone who is hypotensive. They might as well have asked him to chug a bottle of hard liquor, another poor ‘anesthetic’ that would likely exacerbate the problem.

I would doubt that in a modern hospital you would find many patients being denied anesthesia for any good reason. We can treat or prevent many of the side effects some anesthetics cause and there are several different types and varieties of drugs, so the anesthesiologist could just try a different mix if there was an unresolvable concern. If there was really nothing that be done I would imagine they would not do a procedure rather than try a bedpost and leather strip mastectomy as described above. Says what you will about western medicine, but studies have shown that cutting open screaming thrashing patients usually doesn’t help anything and will often make the problems worse. Imagine that.

[Kobal2]

@Melbourne

I never had anesthetic at the dentist when young. I used a relaxation/self hypnosis technique. Until two things happened.

(1) He went in much harder and longer than planned.

Are you *sure *he was a real dentist ?

[Leo_Bloom]

@Backcountry_Medic

… I have seen several grown men crying after having emergent chest tubes placed sans local or general anesthesia, but they were all tears of joy at having their lives saved in the face of imminent suffocation from a tension pneumothorax. There is nothing like slowly feeling yourself take shallower and shallower breaths until you can’t get any air at all to instantly erase the limits of your pain tolerance…

Guessing from your username, you weren’t a helpless bystander at these horrific events.

May I ask if you were in the service?

Or do emergency room physicians come across this?

[Yllaria]

You had to go and give me something to look up.

@Velocity

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.) . . .

OK, anesthesia was available in the Civil War and a properly stocked field hospital would have had it. . . probably. There were supply problems (scroll down to #2). There could also be difficulties getting the wounded to the field hospital. So both of the scenes that inspired the question were supply/logistics problems. Well, the Civil War one could have been just inaccurate. Sorry, I had to know.

And sorry to continue the hijack, but I think we’ve pretty much determined that there’s no operation that requires no anesthetic.

@Kimstu

Not surgery exactly, but as a child forty-odd years ago I had stitches in my eyebrow with no anesthetic. I think they didn’t want to leave the eyelid area numb for fear my little pokey fingers might hit or damage my eye.

When my oldest was a year and a half old, he fell and cut his cheek. The doctor in the ER recommended doing the stitches without anesthesia. He explained that to give him the anesthesia, he’d have to get one stick and that spot would be numb for at least an hour, which could worry him. Without anesthesia, it’s two sticks, but then it’s over.

We went with the two sticks. He hadn’t mentioned it, but the needles for stitches are the size and shape of eyelashes. They hurt, but they’re not as scary as a hypodermic coming at your face.

[Little_Nemo]

I have a friend who has an idiosyncratic reaction to opioids; they essentially have no effect on him. Doctors and dentists have given him high dosages of various painkillers and they’ve had no effect on him.

[spamforbrains]

And here’s the tale of Vijay Welch-Young who had major surgery without painkillers.

No, they gave him painkillers- a lot of local anesthetic. Read it. He really only felt pain when they broke the ribs. The rest was just feeling pressure.

[Siam_Sam]

@Drum_God

In the HBO miniseries John Adams, there is a scene where Adams’ daughter has a mastectomy due to breast cancer. Each of her limbs was tied to a bedpost and she was given a piece of leather or something to bite.

That didn’t seem like fun.

And I think that was the basic procedure under Prime Minister Thaksin’s cheap healthcare scheme in Thailand earlier last decade.

[Leo_Bloom]

Obligatory mention of the kid who cut his arm off in the desert rocks somewhere.

[Velocity]

@Leo_Bloom

Obligatory mention of the kid who cut his arm off in the desert rocks somewhere.

In the OP:

@Velocity

I am not referring to situations where anesthesia is unavailable