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  1. #1
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    Local anesthesia for knee arthroscopy?

    I'm finally scheduled April 9 for an arthroscopy to clear out an inflamed medial plica that has bothered me for 5 years and not responded to multiple PT efforts, explore the medial meniscus for a likely slight tear, and to take a closer look at the lateral knee for a bothersome snapping, pain, and peroneal nerve irritation that remains undiagnosed at this time from exams and MRI. Might be lateral meniscus related - we aren't sure until he goes in there and looks.

    Anyway, I've been reading here and elsewhere about anesthesia options; seems like most folks go general or spinal with some sedation. Never had general anesthesia, and am kinda freaked about the spinal for some reason. Has anyone done just local or regional anesthesia with IV sedation (versed baby!!) for a knee scope? I used this option when I was 20 to have my tonsils removed and it seemed to work great, but that was not a knee scope. Any experiences you've had with anesthesia for a scope would be appreciated, thanks!
    Last edited by peterslovo; 03-26-2008 at 08:31 AM.
    "A local is just a dirtbag who can't get his shit together enough to travel."

    - Owl Chapman

  2. #2
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    I see a future MTV Jackass episode in the making.

    OUCH!
    Every man dies. Not every man lives.
    You don’t stop playing because you grow old; you grow old because you stop playing.

  3. #3
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    Quote Originally Posted by Jim S View Post
    I see a future MTV Jackass episode in the making.

    OUCH!
    Hmm, ok 1 big thumbs down for local, though I think for Jackass they'd clearly opt for no anesthesia whatsoever.
    "A local is just a dirtbag who can't get his shit together enough to travel."

    - Owl Chapman

  4. #4
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    I did local with no sedation or IV for that matter. You get to watch the whole thing on the screen. He even took me on a magical mystery tour of the knee at the end. Very cool. It's no problem at all. The worst is probably the big freakin needles the anesthetist jams way into the knee and the two boobs left on the front from all the juice he injected.
    It's not so much the model year, it's the high mileage or meterage to keep the youth of Canada happy

  5. #5
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    I did spinal for a tib/fib nailing so that I could stay awake to watch. It was at the hospital I used to work at so I knew everyone in the OR, including my buddy who was an ER nurse that they let scrub in to run some video. It was awesome--like little shop of horrors. Looked like something you could do in your garage with these big drills and mallets hammering away, and lots and lots of blood. But alas, after about an hour and a half, I couldn't take the tourniquet digging into my hammy so they increased the drip, and I drifted off to never, never land.

  6. #6
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    Versad + spinal for ACL recon. They started the versad first and I barely remember them rolling me on my side for the spinal. Definitely didn't feel any pain. With the spinal, as soon as you can pee again you are free to leave.
    To the Thingmajigger!

  7. #7
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    I wanted to be totally out when they did my ACL. It was beautiful.

    I woke up as if nothing had transpired. Of course the day after was different.

    .
    Every man dies. Not every man lives.
    You don’t stop playing because you grow old; you grow old because you stop playing.

  8. #8
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    I think they tend to want you out during the procedure--not general, but sedated to the point of being out. I came to during my first surgery and began bothering the surgeon. I think he gestured to the anesthesiologist to hit me again when I began pestering him to remove the screen that was blocking my view of my knee, but I did get to watch the video screen of the inside of my knee for a few minutes. For the three other surgeries I didn't regain consciousness until I was in the recovery room.
    [quote][//quote]

  9. #9
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    Angry

    Quote Originally Posted by milton View Post
    Versad + spinal for ACL recon. They started the versad first and I barely remember them rolling me on my side for the spinal. Definitely didn't feel any pain. With the spinal, as soon as you can pee again you are free to leave.
    Yeah, except when you're peeing you don't know it!
    Feels so weird afterwards.

  10. #10
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    Has anyone used a femoral nerve block? Video with music from Hendrix and everything...funky.

    http://www.nysora.com/techniques/femoral_nerve_block/
    "A local is just a dirtbag who can't get his shit together enough to travel."

    - Owl Chapman

  11. #11
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    I've had pretty much everything for all my various knee surgeries except the local.

    Spinal and epidural are pretty much the same. Spinal is just an injection and lasts about an hour - good for short surgeries like a clean out. Epidural lasts as long as needed so is better for acls, etc. For both these anesthesias though it takes a while for the numbing to totally wear off and they won't let you leave until you can pee and they're sure you're not nauseous at all.

    My new OS here prefers generals I guess as I asked last time if I could have a spinal so I could watch and the anesthesiologist said no can do. Maybe that was just his preference but I found the recovery to be much quicker than with the spinals/epidurals. No lower body numbing to wear off.

    I had a femoral nerve block after my 2nd ACL and it was wonderful! I strongly recommend it to anyone having ACL recon. The block was done when I was in recovery after surgery and it lasted a good 36 hours. You have to be very careful moving around and be non weight bearing during that time as obviously your leg is numb but it was so worth not having any pain that first couple days. Didn't know they do femoral blocks for actual procedures.

    The most important thing I've learned from my surgeries is that the anesthesiologists love nothing more than to make and keep you happy. You'll get some valium at the start to take the edge off. If they're going to do a spinal or epidural and you're freaky about the thought of it just tell them you're not happy enough and you'll get more. You'll be awake but only enough to respond to their requests. The spinal/epidural injection procedure is not a big deal. You won't feel a thing.

    It'll all probably come down to what type of anesthesia your anesthesiologist prefers. Just tell them first thing you want them to make you happy and you'll be fine. Good luck!

  12. #12
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    I've always opted for general. The first one I woke up nauseated, but the last four they give me some anti-nausea drug and I wake up happy (like I want to hug people) and feeling great. The only side effect is the scratchy throat and funky "anesthesia breath". Yeah, it would be interesting to see what's going on - but my surgeon shows me photos afterwards and the big needles involved make an epidural/spinal/whatever a big "hell no" to me.

    Plus - why set yourself up to be spending more time in the recovery room waiting for it to wear off to go home?
    "Life should not be a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming, "Wow, what a Ride!"

  13. #13
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    I plan on watching mine for sure. That is all.
    "Why do I always get more kisses on powder days?" -my wife

  14. #14
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    you got it

    Quote Originally Posted by altagirl View Post
    I've always opted for general. The first one I woke up nauseated, but the last four they give me some anti-nausea drug and I wake up happy (like I want to hug people) and feeling great. The only side effect is the scratchy throat and funky "anesthesia breath". Yeah, it would be interesting to see what's going on - but my surgeon shows me photos afterwards and the big needles involved make an epidural/spinal/whatever a big "hell no" to me.

    Plus - why set yourself up to be spending more time in the recovery room waiting for it to wear off to go home?
    I realize I'm 8 years kinda late on this thread although it is still very relevant.

    I'm know there have been many successful spinal blocks and epidurals but not in my case. I have been having (delayed) post dural puncture backaches and I am already 8 mos post op for an orif on my ankle.
    The Dr's didn't warn me about that and I found out they usually don't because it is rare. They only warn you about having an allergic reaction and asphyxiation. Hmm. In hindsight I would have put up with the nausea and eating gravol from being ' put under' rather than this. My other point is trying to get the DR's help with the problem sucks its like they think I'm making it up. I think they cover each others tracks b/c I tried to call surgeon and they told me to call family Dr and then I call family Dr he gives me meds! I don't want drugs I want to know what's wrong with my back!

    Oh yeah and as far as the Short term post op i waited 3-4 hours for anaesthetic to wear off from spinal. Could not pee. Took 4 cathaters all at the same time due to spasm to drain pee sorry tmi but its true you definitely want to weigh your pros and cons beforehand. I'm with altagirl on this one

  15. #15
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    Don't understand the reluctance to go general anesthesia.
    You go to sleep, and if there is a problem you don't wake up.
    You will never know it.

  16. #16
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    Quote Originally Posted by rod9301 View Post
    Don't understand the reluctance to go general anesthesia.
    You go to sleep, and if there is a problem you don't wake up.
    You will never know it.
    this.

    And .. some ortho work is like carpentry .. saws and drills and hammers and tools like I used in lumberland.

    Those images, noises, and smells ... can't be forgotten now.

    General is easy. Stress free. Anti-nausea for re-entry if you ask.
    Wake up, tinkle, gas a morphine. Then enjoy the ride home.

    ... I'll take the butchers word for it.

  17. #17
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    my wife had a spinal for an ACL--it took hours in the recovery room for it to wear off enough for her to go home. I don't recommend a spinal or epidural for any outpatient procedure. The difference between general and local with sedation is becoming blurrier all the time. If they give you versed you are for all intents and purposes out. I've had a couple of hernias done that way as well as a colonoscopy and don't remember a thing, other than with one of the hernias I screamed when the surgeon made the incision. It didn't hurt but he was my friend and partner and I wanted to freak him out. They shut me up after that. I've done a couple of hernias under local without sedation because the patients insisted and both went fine, but it takes a certain kind of person to undergo that. I'm not an orthopedist but I think there are enough pain receptors inside the knee that I wouldn't want it done that way. I'll go for the general. I did for eye surgery, and a lot of that is done with local and sedation.
    That said a drunk anesthesiologist killed a 15 year football player having shoulder surgery at Tahoe Forest in Truckee, many years ago. So don't have a drunk anesthesiologist.

  18. #18
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    my bud the anesthestist always gave the advice to ask for "the Cadillac ride"
    Lee Lau - xxx-er is the laziest Asian canuck I know

  19. #19
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    My dad was a chest cracker in a MASH unit and the inspiration for Hawkeye.

    He always told me, "I'm not the guy that's going to kill you, it's the anesthesiologist."

    Most insurance now, doesn't even let you choose the anesthesiologist. It's usually a group, whomever is on that day and more frequently, a CRNA.

  20. #20
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    Quote Originally Posted by Shredhead View Post
    My dad was a chest cracker in a MASH unit and the inspiration for Hawkeye.

    He always told me, "I'm not the guy that's going to kill you, it's the anesthesiologist."

    Most insurance now, doesn't even let you choose the anesthesiologist. It's usually a group, whomever is on that day and more frequently, a CRNA.
    That's funny--I knew an ER doc (ex surgeon) at U of Az back in the 80's who was rumored to be the inspiration for Hawkeye. There are probably quite a few other guys as well.

    You bring up a good point. While you may go to a doc in your network and have it covered by your insurance, the surgeon may use an assistant and/or anesthesiologist who is not. Your insurance may not pay any of the assistant's or anesthesiologist's bill or they may pay them their contracted rate, after which the non network doc can bill you for the balance, which can be 50% or more. Also insurance web sites are often wrong or out of date. In the case of anesthesiologists there may be no network doctors in your network hospital. All of this should be illegal--anesthesiologists (and radiologists, pathologists, and other hospital based specialists) should be required to accept insurance companies' contracted rate for every insurance their hospital contracts with as payment in full as a condition of hospital privileges and the insurance companies should be required to pay them. Insurance companies should be responsible for full payment to doctors erroneously listed on their web sites.

  21. #21
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    Dad's nickname was Deadeye and he was in the 8055, as was Hornburg. He probably has some Frank Burns in him too.

  22. #22
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    Quote Originally Posted by Shredhead View Post
    Dad's nickname was Deadeye and he was in the 8055, as was Hornburg. He probably has some Frank Burns in him too.
    I'm not sure Deadeye is the best name for a surgeon.

  23. #23
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    It is when he's the guy shooting the rats under your bunk with his 45.

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