My daughter fell while exiting a bus a little more than two weeks ago, and broke her ankle in three places. She had surgery last week, and the surgeons put in a metal plate and some screws. She was given general anesthesia. I was a bit surprised; I thought she would have been given a regional, since it was her ankle. I didn’t speak to the anesthesiologist, but I was wondering why. Anyone have an idea?
IANAD, but i did stay at the Holiday Inn at some point. A ankle broken in three places I think would qualify as major orthopedic surgery, given how small the area is and it’s importance to being able to walk. general anesthesia insures no movement whatsoever, Whereas a regional block might remove any sensation of pain, but might not prevent a reflexive movement down there during the middle of the surgery.
There’s also the freak-out factor to consider. Anything to do with bones (sawing, drilling, whatever) tends to be pretty noisy and messy, and you really don’t want to be awake for that.
Also, long procedures are boring. Sometimes I wish I could sleep through dentist visits.
Incidentally, I woke up during my first knee surgery. It hurt, but the anaesthesiologist just said, ‘We’re almost done, so just hang on.’ (It didn’t feel like they were ‘almost done’. It hurt!)
I learned the hard way that my periodontist doesn’t want me to sleep through a gum graft. (She started to play music on her phone.)
Because blood pressure rises when you’re aware that someone is chopping at you. And even more so if they make and have to rectify an error during the chopping.
Definitely not a long procedure - they rolled her out of pre-op at 6:10 PM, and she was in recovery by 7:30.
IANA medical anybody. But my wife had a similar ankle repair done many years ago.
AUIU, orthopedic procedures are kinda violent. Lots of pushing and shoving getting everything squared away & bolted down. Even if you felt nothing and remembered nothing, that might be hard to take at the time. Inert unconsciousness sure simplifies things for the folks working on the patient.
This. Been a while since I assisted in such procedures, but there are hammers and chisels and impact wrenches employed, with burly surgical assistants required to twist and and life and pull and push to get things aligned. Burning bone smells nasty as it’s being drilled at times too.
Besides, regional blocks can be iffy; some nerves get deadened, some may not.
Yeah, my mother was an operating room nurse for about 30 years, so I heard a few stories over dinner. Knock me out, please!
If the surgery puts the patient in a very vulnerable position, wouldn’t it be important to have them completely paralyzed? You can’t do that with regional, can you?
I’m thinking of cases where a long rigid stent goes in there, and a cough or other sudden movement would tear things up (I read that one somewhere). Or the surgery my friend just had, peeling a tumor out of the lining of the spinal cord. Any movement of the patient’s body could have been catastrophic.
BTW I did wake up on the table during a lithotomy. I remember one person announcing “Hey, he’s awake!” and somebody else saying to me “Hey, you, go back to sleep, you don’t want to be awake now!” It sure did hurt. I remember thinking it disappointing that such skilled and educated professionals would start their sentences with “Hey!”.
That may not have been a certainty ahead of time.
General makes more sense to me for several reasons. Because of the number and likely locations of the fractures, several big nerves were involved. Local would therefore require multiple injections. Local is also more useful for quick things and more complex or potentially time-consuming tasks are better controlled with general. General requires slightly less expertise and experience and back-up equipment like ultrasound. Also watching certain procedures may be traumatizing, especially for those at extremes of age. Complications are often easier to manage.
Watching orthopaedic surgery has similarities to carpentry and such.
My husband had knee surgery (10 days after my wrist surgery - truly excellent timing) and they did an epidural plus something general that was a step above procedural sedation but below full on general with intubation. They offered him a regional block that would have numbed the whole leg, for post-op pain control or something, but he opted out of it.
Others who know more about the topic have given better answers than I ever could - but from my own experience with failed non-general anesthesia (I quite frankly FREAKED when they said they were doing an epi on him, as I’ve had them and they Do Not Work on me) it’s possible that one concern is indeed incomplete pain blocking.
For my wrist surgery - which was somewhat involved, as it involved taking a tendon from one side and transplanting it to the other, among other fun stuff - I did have a regional - supraclavicular block - along with some kind of general anesthesia (may also have been a “step down” from full on intubation, but I wasn’t there for it, so I don’t know). The regional actually DID work for me - they did it after they gave me the happy juice, so what looks like an unpleasant experience was a nonevent for me.
A friend who had surgery on both thumbs for trigger finger opted for a local / regional only, as she is terrified of general anesthesia. She told us later that apparently due to her stress, her BP began spiking so high that they debated aborting the procedure.
Your anesthesiologist was an ass. I hope you filed a complaint - because frankly, your waking up was proof that he was not doing his job right.
I was 17, so…
Many procedures are indeed done under regional anesthesia, which reduces the dosage needed for general anesthesia. I do understand why the doctor wanted to put her under, even if a regional block would have rendered it painless.
My urologist offered both options when I went for a vasectomy.
I opted for local, but closed my eyes and tried not to think about what he was up to. It was a little uncomfortable- both physically, he’s pulling tubes out of my ballsack - and socially, he’s pulling tubes out my ballsack. Also the burning flesh smell.
I had planned to just take an Uber home, but my wife was kind and picked me up about 30min later. Otherwise on general anesthetic I would have been in the recovery room for several hours.
When my chemo port was installed, it was under twilight anesthesia, which knocked me out as intended, in an OR. When the port was removed, it was with regional anesthetic in the office. Different technical needs for adding and removing the same piece of hardware 5 months apart.
Holy cow.
I will never read anymore of your posts.
= )
I wasn’t offered anything but a local and then drove myself home. I must admit the tugging on my vas deferens was odd.