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All surgery prior to the mid-19th Century was done without anesthetic (unless you consider “shitloads of alcohol” an “anesthetic”). I don’t think they did open heart surgery back then, but there were plenty of brain surgeries. Trepanning, for example, and more.
Following my open-heart surgery, I was on a very strong pain killer for a month. Was he able to control this amount of pain continuously, for all that time, even while he was asleep – while dealing with simultaneous general weakness? Or did he wake up screaming, trying to regain control? The mind boggles that anyone can have that level of “control” over such a long span of time.
I would imagine surgery is not just about being pain-free. It’s also about immobilizing the patient. I had a biopsy done and the local didn’t quite take, and I tried my best to stay still but there were times I couldn’t control my tics and jerks as he poked a needle into my boob.
I think it’s easier on the doctors, too. Knock the patient completely out, then the surgeon can do what they need to do.