I’m getting knee surgery on Thursday, and I’ve got the option of a spinal block with sedation or general anesthesia. The anesthesiologist is leaning towards general because he thinks my surgery will be longer than one hour but shorter than three hours - I’d be sitting around waiting for my legs to come back so they could send me home. Whereas if the do general, out I go and they bring me right back up when they’re done.
I went to get this done last week, but left the hospital without actually getting it done because the surgery scheduled before mine ran long. I posted about it here.
Anyways, I was fine with them doing the general, but now I’m having second thoughts, and I was wondering where you all weigh in on this subject. Obviously, I’m not soliciting medical advice - only opinions.
Well, I’ve had my ACL replaced and both medial meniscuses (menisci?) partially removed , as well as achilles tendon repair done. So I’ve had both.
Of all my surgeries, the anesthesia method I found most enjoyable was this: I stared with the spinal block, got a chance to see the inside of my knee on the monitor, watch them doing strange things to part of my leg without being able to feel it. It was pretty cool.
Then it kind of stared getting to me. So I told the anesthesiologist [Oliver Twist]“Please, sir, I want some more.”[OT] And he knocked me out.
We had talked about that possibility ahead of time.
If you’re getting a skin graft…get knocked the F out.
I have not had knee surgery, but…I loathe the epidural/spinal block. I had to have it twice – I wasn’t given a choice either time – and it 1) hurt my back like a motherb!tch, 2) gave me the most godawful headache evar, and 3) caused my BP to drop like mad (to the point that they were literally giving me cocaine via IV to get me to “normal”). YMMV, but you asked for opinions and mine is such that I prefer general anesthesia.
With GA, I have to be given a dose of phenergan prior to being brought out, have a nausea patch stuck on me and then another dose of phenergan as I regain consciousness to prevent me from puking my guts out, but that is *nothing *compared to the issues with epidurals for me. The backache and headache caused by my epidurals lasted about 3-4 days each. The doctor tried to say that it was “all in my head” but the nurses confirmed that many patients have the same reactions. Being as how I am quite the opposite of a hypochondriac (think MP&THG “'tis but a flesh wound”) for me to complain about a backache/headache lasting that long – it’s not psychosomatic.
Of course, I remind you (IANAD and all that rot) to be sure of your medical history – particularly breathing issues/sleep apnea/etc – before doing GA, and it is ultimately up to you and your doctor as to which you choose. I would discuss your concerns with your doctor/anesthesiologist and go from there.
That seems like a rather odd thing for the anesthesiologist to say. True, after a spinal one has to wait for one’s legs to function again, but it’s not like you just hop off the bed and drive home after general either. Even with modern well-calibrated anesthesia, you usually have to spend some time in recovery. A few years ago, I had the same procedure twice in the space of 4 months – once under general anesthesia and once with a spinal (and some sedation). I spent about the same amount of time in recovery with both, but it was a heck of a lot more pleasant with the spinal – I was awake and alert the whole time and felt much more in control (except for the whole paralyzed legs thing, of course).
My SIL had a spinal for her first knee surgery and she ended up spending a day or two longer in recovery because she couldn’t go to the bathroom on her own - which they said was a result of the spinal. She also ended up with a UTI from the catheter (and uhm…well she had a catheter!) which made her miserable.
Her second knee surgery, she went for full-out. She got home a lot quicker.
I have had ops on general, spinal and I had the parathyroid specific local.
It all depends on how squicked out you are by blood and guts and gore. I had a blast under a spinal getting a tubal ligarion. I had a tumor removed under general [mainly because I just wanted to be knocked out, I was seriously stressed out at that time for many reasons] and getting my parathyroid removed was way neat. Except the gas passer had terrible jokes and there really wasnt a way to set it up so i could watch
Oddly enough, this past op, the gas passer and I had a long discussion about local vs general, and one of the things we discussed was the nausea and hurking issue with general - she didnt seem to think it was in peoples minds. We both realized that I wanted the local but by hospital rules we had to discuss both versions.
To be honest, I would almost always go with remaining awake - I have a fear of the whole seems to be out but can really feel everything… :eek:
My experience very closely resembles **Litoris’ **description.
I had spinals for my two c-sections, I puked before the surgery ever started, my BP dropped way down (although I have no idea what got pumped in my IV to get it back to semi normal), and with the second one I had a wicked spinal headache.
I also struggle a LOT with nausea when I have GA, to the point that I tell them ahead of time forget the stupid pain scale, ask me about my nausea. It’s really truly that bad.
Even so, I would still not willingly choose a spinal again.
I don’t remember what the name of the drug they gave me was, but at the time, I asked and when I looked confused, the nurse whispered “it’s basically medical-grade cocaine – don’t worry, the baby will be ok.” Yes, I was pregnant at the time. It was actually a scary situation, since I tend to run low BP anyway (low as in 80/40 is relatively normal for me, so when that drops :eek: ). This was given to me after 45 minutes of epenephren (SP?) – to the point that they were afraid of an overdose, without any rise in BP.
With GA, I just always make sure that the recovery staff is fully prepped with my issues – I make them do the nausea patch before I go under, to be sure that is at least in place. Pain, I can deal with – puking right after major surgery, not so much!
I had ankle surgery to repair it after I broke it in three places at once. While I was waiting to go in the anesthesiologist noticed on my chart that I was a music student at the time. I don’t know why that was relevant to my health, but there it is. He asked me if I sang, and I said I did. He said oh! Perhaps you’d like to have a spinal, instead of a general anesthetic. Under the general, apparently with intubation, there was a risk my voice might never recover or suffer permanent damage :eek: . Not attesting to the veracity of this statement, just stating the reason for my choice. I went with the spinal.
I’ve never had to go under general anesthetic for another surgery, so I have little with which to compare my experience. I can say that they made me groggy during the surgery so I don’t remember a whole lot. Getting the needle itself hurt somewhat, but doesn’t last long. I didn’t feel a thing during surgery and had a relatively short time in recovery, though I remember my legs being numb for a number of hours afterwards (that wasn’t so bad either, since it can’t hurt then, right?). That same night I was using a walker to get to the bathroom one-legged. They wouldn’t stop giving me IV fluids so I could get some rest instead of having to pee every half hour! One nurse told me this was unusally good progress, probably only due to the fact that I was young and relatively fit, more so than that I possessed astounding healing powers. I was home the next day.
It was a good experience for me, as far as surgeries go, but I didn’t suffer any reactions to the anesthesia as others have (yuck!).
I’ve had general a couple of times for surgical procedures, and spinals a couple of times for labor/delivery. I found the general to be rather unpleasant to wake up from…I was very groggy for a long time, and felt sick for a couple of days. The spinal, on the other hand, worked great for me…I had no back pain or headache, although I understand when people get those, it is really, really bad. The second spinal I did have breakthrough pain at the end (right during delivery! Yikes!) but that was because my labor took much longer than expected. With a (relatively) short surgery, they probably can manage it better.
I’ve had a spinal once, for kidney stone blasting. It was pretty uneventful and I don’t remember minding any of it.
I’ve had general perhaps 15 times or so. Usually everything is fine. One time I woke up feeling utterly contented harmony with the universe and spent the whole day in blissful grace. Another time I threw up on the ride home. I get the idea there are a lot of choices in general anaesthetics, and wouldn’t mind knowing more about it so I can suggest the methods that work well on me. Especially the harmonious one…
I want to recommend spinal if it can work for you.
I have had several surgeries in the past few years and I swear that I am the worse for wear because of them. My memory does not seem as sharp and I don’t think I am as quick as I was.
However, please note that my surgeon has told me repeatedly that if this is indeed the case the anesthesia is not the cause. (He doesn’t deny that it *may *be true, he just says it isn’t because of anesthesia.)
Whatever you choose, sending lucky thoughts your way.
I have very strong opinions on this. I’ve had 5 knee sugeries over the years, and been on the table a few other time just for good measure.
In my opinion the only way to fly is via a spinal, assuming you can. In general, the doctors I have dealt with really want me to use general and will push it if not actively resisted. They tell me it is up to me, all the time making excuses for why a spinal isn’t right for me. The last time, one doctor even told me “only women get spinals”.
My experiences:
Spinal:
It’s kinda creepy when someone messes with you back, and you know there’s a big needle back there. The last time I had one, they told me if I couldn’t sit still (it tickled!) they would have to give me a general.
Once, the spinal caused me to not be able to pee for about 24 hours. With the IVs and all the water thay made me drink I was hurting before too long but couldn’t get the plumbing working. Eventually they had to catheterize me (not as bad as it sounds).
I woke up once and could hear, and sort of feel, them hitting a hammer on something metal. Then I went back to sleep.
General:
Easy for the Docs I think, so they like it.
I’ve woken up freezing and miserable every time.
The last two times I have thrown up for hours afterward. “That’s normal”, the cheery nurse says.
A strange generally woozyness for days after … or maybe that was the morphine.
Get the spinal - ask for something to make you sleep through the operation.
And my surgery tips I give everyone:
Take a good book
Ask for extra warm blankets - they have a warm blankets there and you will be laying almost naked in a cold room! Ask early and often for MORE warm blankets.
Imagine yourself in a spa rather than a hospital - read your book and ask for warm blankets!
I’ve had both—spinal and general—and found the spinal a piece of cake. But so was the general.
The spinal was so utterly painless, I insisted the anesthesiologist do “dull-sharp” just so I could rest easy. He found this quite amusing but granted my request.
Dull: the blunt end of anything - say the other end of a hypodermic needle
Sharp: the pointy end of a needle.
He hits you with both in the anesthetized area and if he did his job (which is about 101 times out of 99), you can’t tell the difference. All you feel, at most, is pressure.
If you get a spinal, will you also get IV sedation so you go nighty-night during the actual procedure? I can’t think of too many thing more dreadful than being on the table, awake, while they’re cutting on my leg for any length of time. The advantage of general is, you get it, then you wake up and it’s done.
FWIW, when I’ve had general anesthesia (once the full blown version with intubation and everything, and the other times with IV sedation so I remembered nothing), I never had any stomach problems. If you tend to queasiness that might be a factor.
Oh, and of course I don’t know what the failure rate of spinal anesthesia might be, but I’ve had epidurals twice. They did not work well either time. When one of those times involved scalpels, this was not so good. As a result, I will never allow any sort of spinal / epidural anesthesia for myself. Anyway - I’d suggest finding out what the game plan is if they give you the spinal and it doesn’t do enough.
And I always have trouble regulating my temp for weeks after. I - who usually go without a coat in all but the most bitter cold - would sit and shiver in 72 degree temps. The doc says it is normal.
