General vs local anesthesia
 

Hope it's okay to ask this.

I need hand surgery on tuesday - inserting some pins and such to correct a weekend accident.

When surgery was first advised I asked about local vs general. The PA said that might be an option but was a little surprised by my request. Didn't say too much to guide me one way or another. He had heard of this approach being used but didn't know if the local surgeon ever did it this way.

Later I spoke with a physiotherapist who said: " do not do local when pins are involved. General is better unless you have a high threshold for pain".

Met the surgeon today. He said it's day surgery so I immediately asked about local. He said blocking from the shoulder down is an option. Unlike the PA he didn't seem surprised, however the nurses were.

I am getting mixed signals and maybe my expectation of local is wrong in this instance. Am I missing something?

thanks

Anytime bone is involved, it HURTS. There also is the off chance you could move unintentionally, and cause damage if you have a local. Personally, I'd take the general, and I have a high pain threshold.

my advice....ask for an LMA general and local infultration with marcaine. No tube through the vocal cords to irritate the throat and you wake up with a comfortable hand.
The LMA has some field practical use in a pinch...ask to see it, it will make you wonder...but it works.

Laryngeal Mask Airway

Thats going to be more up to who does the induction wont it? Obesity and Hx of DM will contraindicate them Ive been told as well as posterior airway-

Don't forget to get pics!

Thanks for all the info. I will ask about the LMA.

LOL - :D How would I do that?

Had three surgeries on the same hand (digit) over a two year time frame...by far my most pleasant was the Bier's block.
It was awhile ago...should talk to your Anesthesia Pooba to see what he recommends as well.

Good luck

PA

With your other hand.

TR

What Reaper said. LOL. Just tell them. They probably want some too and will take them anyway while you're asleep.

Blocking was the term used in my 5 min conversation with the surgeon. No details. Isn't it something like oral surgery; Aware of the drilling and hammering and such?

Thanks.

Awake is different from awake and remembering. Anethesia dude has one purpose-to enhance your experience through chemistry and then not let you remember any of it..
Blocks are ALWAYS safer, and if they think you are too wiggy being awake or you are uncomfy-they can always drop you into general.
Not gospel, just a point of view.


Eagle

Eagle has spoken the gospel.

Here is how I explain the levels of anesthesia so my patients can understand it:

1. Local/regional nerve block with no IV sedation... shouldn't feel pain but will be very aware of what is going on. You will be completely awake and aware.

2. Local anesthesia/regional nerve block with IV sedation... No pain should be felt and you will breathe on own and still be semi-conscious to respond, but you will have amnesia about what actually took place when you "wake up". So even if it hurt a little or was uncomfortable due to sounds/movements during the surgery, you won't remember it.

3. General anesthesia... Good night Irene- wake up afterwards but you were intubated,etc.

I've had all three, more than once, general 4 or 5 times. General anesthesia is fine, just sucks waking up in the post Op room with a nurse shaking you every five minutes.
TS

That helped. I had visions of 1. Must be option 2.

I knew one of you would say that !
I need to practice before Bush gets here saturday.

I'll ask; I expect you want it when all the parts are disassembled? :p

Thanks Everyone,
A Dudette

The type of surgery you are describing, a block is ideal. Not only do you have anesthesia at the surgical site, it will remain pain free in the immediate few hours after surgery. Time for your oral analgesia meds to kick in.
I never do a regional block without some sedation. And I use alot. It's cheap and the patients seem to appreciate it.
Generaly at least a couple of milligrams of Versed before the block with 50-75 mcgs of Fentynl. And prior to prepping and drapping a few more milligrams of Versed and 50 to 100 mcgs of fentany. And if it is to be a long procdure I will start a diprivan drip to keep you lightly napping thoughout the procdure.
The Versed helps you (the patient) not remember much of the procedure.
Regionals are one of the safest forms of anesthesia and for extremity surgeries they are highly recommened.
Generaly I reccmmend a regional to the patient, frequently the patient whats too be "asleep" for the procdure. So we gives them what they want, and they end up with a general. Besides the reimbursemt is better for a general.