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Old 26.05.2015, 15:57
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local/regional/general anesthesia

Hi everyone,

I am about to undergo surgery in Kantonsspital Baselland (removal of a small 2.5 x 1.5 x 4 cm cyst on my lower back) and the anesthetist tells me I have to chose between local, regional or general anesthesia. I will have to stay in the hospital for 2 nights regardless of what I choose.

Any suggestions? What are the pros and cons of each based on your experience?

Thanks in advance!
Nenad
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Old 26.05.2015, 16:17
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Re: local/regional/general anesthesia

Personally I would go for the local anaesthesia. It has none of the risks associated with a general anaesthetic, and recovery is faster.
I am guessing that regional anaesthesia is like an epidural? This is where a larger area of the body is numbed, in your case probably the pelvic are and legs. but you are still awake. Again there are risks, but only rarely.
If you prefer to be asleep and not know what is going on, having your op in blissful ignorance, you could go for the General anaesthetic option.

However, I am not an anaesthetist, in my work we used only local anaesthetics on the foot, so hopefully someone else will be able to help more.
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Old 26.05.2015, 16:33
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Re: local/regional/general anesthesia

Pretty much as hannah'saunt says. For something like that probably the local would be best, but if you really, _really_ don't want to feel a thing then regional anaesthesia may be better. Like a local you're still wide awake, but the nerves in or close to the spinal cord are themselves numbed so there should be no sensation at all.

Risks are lower with the epidural type, most likely for this sort of thing, slightly higher with peridural, where the injection goes directly into the spinal column rather than just around it, and is used for more complete paralysis, for example for complex knee/leg surgery (like I'll be having in August).

General anaesthesia tends to be used as a last resort, as risks are much higher (although still low). This would be used for abdominal, thoracis or back surgery, as well as in cases of severe trauma where it's the simplest way to switch the patient, and their suffering, off for a while. Also sometimes used if spinal injections are contraindicated for any physical or psychological reasons.

From the patient's perspective, a general will leave you feeling sick and tired for a long time after, and such effects, as well as the risks, may be cumulative with longer and/or repeated use. Sometimes, though, the after-op sickness may be down to barbiturates used as a pre-med, so if you're offered something to 'calm you down' a couple of hours early don't be afraid to question it and only use it if _you_ think it's needed.

Oh, and I'm not a medic either, but I've had a fair amount of experience from the patient's viewpoint
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Old 26.05.2015, 18:49
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Re: local/regional/general anesthesia

Thank you both for your opinion(s)!

I ruled general anesthesia out immediately as well, but I am still torn between the other two.

I know the best would be local anesthesia but I'm not sure if I'm "brave" enough for that... I've had some bad experience with local anesthesia in the past.

Do you perhaps know whether regional anesthesia causes fatigue and sickness as well? Wikipedia (my main source of information ) only mentions risks related to regional anesthesia but not potential side effects.

Also the anesthetist said I'd get "spinal regional anesthesia" so I guess that's not epidural. Any first hand experience with that?

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I've had a fair amount of experience from the patient's viewpoint
Sorry to hear that...
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Old 26.05.2015, 18:52
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Re: local/regional/general anesthesia

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Old 26.05.2015, 19:16
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Re: local/regional/general anesthesia

Spinal anaesthesia is indeed an epidural. Many people think it is totally safe, but in fact it is not. The incidence of accidents or severe side-effects are rare, but when they are, they can be debilitating and long-lasting.

I have to have a knee replacement soon- and I shall opt for general a.- it is very noisy and and 'violent' and I want out of there, that's for sure. Terrified enough as it is (and I've never been before- I had my first baby with an epidural for an emergency section (transversal breech) and that was great.).
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Old 26.05.2015, 19:18
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Re: local/regional/general anesthesia

I had two surgeries in the past 6 months and both were performed with a block. I am guessing this is the regional you are talking about.

I had multiple surgeries in my life (don't ask) and never had a local anesthesia but it was always between the general or the block. The block depends how much work is performed I guess and helps a lot to keep pain free, especially when the bones are involved.

Both of the blocks I received in the last 6 months, I have no memories of the surgery. They gave me meds to make me sleep.

I think I know what kind of surgery you are having and I would go with local. It doesn't take long and they can give you something to relax and /or pass out.

You might feel tired that day but that will be it.

Best of luck with the surgery!
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Old 26.05.2015, 19:39
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Re: local/regional/general anesthesia

Local is probably the best choice, but you might want to see if they will give you an amnesia producing drug like versed or something similar. I had a bronchoscopy ( lung biopsy) years ago and they gave me this stuff - i never remembered a thing. They often use similar meds for endoscopies or colonoscopies.

I can't imagine having a knee replacement with anything but a general. Yikes!
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Old 26.05.2015, 21:14
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Re: local/regional/general anesthesia

Some good advice on this thread. As a rule try to avoid general anaesthetic if you can.
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Old 26.05.2015, 21:21
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Re: local/regional/general anesthesia

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Local is probably the best choice, but you might want to see if they will give you an amnesia producing drug like versed or something similar. I had a bronchoscopy ( lung biopsy) years ago and they gave me this stuff - i never remembered a thing. They often use similar meds for endoscopies or colonoscopies.

I can't imagine having a knee replacement with anything but a general. Yikes!
Completely agree with you there.

I had a hole in the heart repair without anaesthesia except for a local at the site of the cannula but was under the influence of the 'happy' drug and don't really remember much about it.

My mother had two hip replacements with only an epidural and she said it was fine. She went into graphic details of all the hammering and sawing that she could hear and I have to say in those circumstances I'd probably have been unconscious after about 30 seconds anyway without a general since I'm a bit squeamish.

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Old 26.05.2015, 21:23
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Re: local/regional/general anesthesia

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Local is probably the best choice, but you might want to see if they will give you an amnesia producing drug like versed or something similar. I had a bronchoscopy ( lung biopsy) years ago and they gave me this stuff - i never remembered a thing. They often use similar meds for endoscopies or colonoscopies.

I can't imagine having a knee replacement with anything but a general. Yikes!
I got my shoulder re-re-re fixed last month under a block. Dont remember a thing.
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Old 27.05.2015, 00:41
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Re: local/regional/general anesthesia

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From the patient's perspective, a general will leave you feeling sick and tired for a long time after, and such effects, as well as the risks, may be cumulative with longer and/or repeated use. Sometimes, though, the after-op sickness may be down to barbiturates used as a pre-med, so if you're offered something to 'calm you down' a couple of hours early don't be afraid to question it and only use it if _you_ think it's needed.

Oh, and I'm not a medic either, but I've had a fair amount of experience from the patient's viewpoint
Well I recently had surgery and it had to be performed under a general. The operation took about an hour. I felt fine afterwards, except for being in pain but that was to be expected.

I have had local anaesthetic and epidural. Usually the anaesthetist will take a detailed medical history and discuss with the patient the various options so you can make an informed decision.
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Old 27.05.2015, 08:23
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Re: local/regional/general anesthesia

Last time I had a general, I had a crick in my neck before going under, and it was gone when I woke up . As I'd asked not to have morphine for pain relief following the surgery, I didn't have the usual nausea that I'd had on previous occasions.

I've also had surgery under a nerve block and don't remember the procedure as they also sedated me. There weren't any lingering effects after the numbness wore off.
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Old 27.05.2015, 09:31
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Re: local/regional/general anesthesia

I've had a gall bladder removed and a lumpectomy, both under general. After the gall bladder, I barfed for a few hours. Nothing after the lumpectomy. They were 15 years apart, but also, the anesthesiologist said that it's easier to avoid nausea and vomiting if surgery isn't in your abdominal area.

in both cases I didn't need morphine for pain. I was however a nervous wreck before both surgeries. I'm like that.
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Old 27.05.2015, 09:42
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Re: local/regional/general anesthesia

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Hi everyone,

I am about to undergo surgery in Kantonsspital Baselland (removal of a small 2.5 x 1.5 x 4 cm cyst on my lower back) and the anesthetist tells me I have to chose between local, regional or general anesthesia. I will have to stay in the hospital for 2 nights regardless of what I choose.

Any suggestions? What are the pros and cons of each based on your experience?

Thanks in advance!
Nenad

I also had a 2-3cm cyst on my back removed, back in 2007. It happily lived on my back for around ten years, until I finally remembered to ask my doc about it who quite happily offered to remove it. This was at IFA in Baden, so work paid for it.

This was done with a local anesthetic in their local surgery, which went well (I could feel the movements) until it was plainly obvious that the cyst was buried a few millimetres deeper than the penetration depth of the anesthetic . At which point the doctor stopped and asked if he should go on (he was almost finished). I told him to go on, which meant 30 seconds of slicing and dicing into non-anethetised flesh. And yes it hurt like hell - I still can 'feel' the pain, so to speak. I took a photo of the cyst afterwards (Dare I post it?)

All in all, made for a bloody good pub-story at the time; especially with the photo

So, local anesthetic is [was kind of] OK [for me]. But a) make sure it penetrates sufficiently and b) can your doctor not do it in his surgery? (As mine did - I was only there for an hour, and was fine afterwards, didn't even need painkillers, just sterilisation fluid and dressing for the wound, and a few beers)
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Old 27.05.2015, 09:53
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Re: local/regional/general anesthesia

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I took a photo of the cyst afterwards (Dare I post it?)
Wait until I'm done, then we can compare them
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Old 27.05.2015, 10:12
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Re: local/regional/general anesthesia

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Hi everyone,

I am about to undergo surgery in Kantonsspital Baselland (removal of a small 2.5 x 1.5 x 4 cm cyst on my lower back) and the anesthetist tells me I have to chose between local, regional or general anesthesia. I will have to stay in the hospital for 2 nights regardless of what I choose.

Any suggestions? What are the pros and cons of each based on your experience?

Thanks in advance!
Nenad
I can't speak for the local anesthesia, but if done correctly, the general one is not bad at all except for the fact that you do feel bad for a few hours, after you wake up. When I was about 20 I had appendicitis so had to have a surgery, and everything went so smoothly, still remember the docs and nurses joking around me till I felt asleep, they were hilarious.
One of my parents had a surgery 2 month ago with general anethesia and it was the same - a bit of dizziness afterwards (and maybe one episode or two of vomiting) but that was all. No side effects, no trauma.
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Old 27.05.2015, 10:25
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Re: local/regional/general anesthesia

Ask the anaesthetist which one they would choose - they have done the procedure many times so would know which one is suitable.

Incidentally, my daughter recently had an epidural and her spinal sac was punctured doing the procedure - she was very poorly for a few weeks, kept having to go back into hospital and is now finally better - rare, but it does happen.
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Old 27.05.2015, 10:42
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Re: local/regional/general anesthesia

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I can't speak for the local anesthesia, but if done correctly, the general one is not bad at all except for the fact that you do feel bad for a few hours, after you wake up. When I was about 20 I had appendicitis so had to have a surgery, and everything went so smoothly, still remember the docs and nurses joking around me till I felt asleep, they were hilarious.
One of my parents had a surgery 2 month ago with general anethesia and it was the same - a bit of dizziness afterwards (and maybe one episode or two of vomiting) but that was all. No side effects, no trauma.
It all depends on the person and how they react to the drugs. Different people react in different ways and for some people the reaction to a general anaesthetic can be pretty bad irrespective of who is administering and how well it is done.
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Old 27.05.2015, 11:05
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Re: local/regional/general anesthesia

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It all depends on the person and how they react to the drugs. Different people react in different ways and for some people the reaction to a general anaesthetic can be pretty bad irrespective of who is administering and how well it is done.
But that should be the same for each type of anesthesia I guess, see smackerjack post. (although she referred to the "mechanical" part of it - the puncture). They all use drugs, btw.
I wasn't specifically advocating for the general one, I just described my limited experience as I saw there were some posts who seemed against it. The most entitled person to recommend which one is the doctor, of course.
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