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Spinal Versus General Anesthesia for knee surgery?

 

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mmrocker13

Aug 12, 09 18:05

Post #1 of 70 (12929 views)
Spinal Versus General Anesthesia for knee surgery? Quote | Reply

I am going in for arthroscopic surgery in October. It is definitely not my first one (I've had three previous), but in all of my prior knee surgeries, I had a general anesthetic. This one, I have the option to choose.

i am wondering if anyone has had both, and can give me an opinion.

I was sort of intrigued with the spinal, b/c I am the type of person that would get a kick out of watching it (assuming they had a screen), or asking questions...but I don't know what happens with that.

Stuff to consider:

I like to watch :p

I AM a puker with anesthesia.

I have had a spinal tap (and the anesthetic that goes with it)...and the spinal headache made me want to DIE (and I am a veteran of migraines). I was incapacitated for almost a week. Would I be at risk of this with the local/spinal anesthetic? B/c, if so...I will take 12 hours of vomit in a second.


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DrPete

Aug 12, 09 18:10

Post #2 of 70 (12926 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

In Reply To:
I am going in for arthroscopic surgery in October. It is definitely not my first one (I've had three previous), but in all of my prior knee surgeries, I had a general anesthetic. This one, I have the option to choose.

i am wondering if anyone has had both, and can give me an opinion.

I was sort of intrigued with the spinal, b/c I am the type of person that would get a kick out of watching it (assuming they had a screen), or asking questions...but I don't know what happens with that.

Stuff to consider:

I like to watch :p

I AM a puker with anesthesia.

I have had a spinal tap (and the anesthetic that goes with it)...and the spinal headache made me want to DIE (and I am a veteran of migraines). I was incapacitated for almost a week. Would I be at risk of this with the local/spinal anesthetic? B/c, if so...I will take 12 hours of vomit in a second.

Even with a spinal, you'd likely get some sedation. So you could watch, but there's a chance you wouldn't remember watching or any conversations anyway. Also, if your spinal isn't doing the trick, the bailout would be general anesthesia.

Spinal headache is a risk with a spinal anesthetic, so it's something to consider. I don't think that having a previous spinal headache would predispose you to another one, but I'm not 100% sure on that.

Really, though, either one is a good, safe way to go, so just talk it over with your anesthesiologist, and specifically mention that you've had a spinal headache before.

Good luck!


TriBri00

Aug 12, 09 18:22

Post #3 of 70 (12908 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

If you had a spinal tap for testing, then chances are good that a bigger needle was used to get more fluid out of you. The risk of headache is much greater with the bigger needles than it is with the smaller needles used for spinal anesthesia. That said you can still have a post-dural puncture headache (aka spinal headache). I'm an anesthesiologist and for a simple knee arthroscopy I'd pick general. For something more painful like ACL repair, then spinal can be more comfortable in the recovery period. Plus if you have a repair done you'll be off your feet for a while, so if you get the headache there are fewer workouts to miss ;). I never did many spinal for knees because they patients go home quicker after a smooth general anesthetic.

You may want to consider a femoral nerve block if you're having an ACL repair. They can give great post-op pain control.

brian

Brian


MI_James

Aug 12, 09 18:22

Post #4 of 70 (12908 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

I can tell you as a guy that has had a leak from a spinal tap, get the general and have the dr. tape the sugery. There is no cool factor that is worth the risk of a leaking spinal column. I have had no other experience in my life that even would get mentioned in the same discussion as a spinal headache. It is not even close. I would rather file my teeth than get another spinal headache.


ggeiger

Aug 12, 09 18:23

Post #5 of 70 (12906 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

I did the spinal for both of mine, and it was great. I was actually talking to the doc as he was showing me the IT bands were fine, no unusual wear, etc, and it totally re-assured me that I was not doing damage to my knees by my exercise. He showed me the actual internal things on the screen, while he was in there. I would do it no there way, and if they said they would have to put me out, I'd find another doc. Good luck....it's VERY interesting, and re-assuring, as I mentioned.


DrPete

Aug 12, 09 18:25

Post #6 of 70 (12906 views)
Re: Spinal Versus General Anesthesia for knee surgery? [TriBri00] [In reply to] Quote | Reply

In Reply To:
If you had a spinal tap for testing, then chances are good that a bigger needle was used to get more fluid out of you. The risk of headache is much greater with the bigger needles than it is with the smaller needles used for spinal anesthesia. That said you can still have a post-dural puncture headache (aka spinal headache). I'm an anesthesiologist and for a simple knee arthroscopy I'd pick general. For something more painful like ACL repair, then spinal can be more comfortable in the recovery period. Plus if you have a repair done you'll be off your feet for a while, so if you get the headache there are fewer workouts to miss ;). I never did many spinal for knees because they patients go home quicker after a smooth general anesthetic.

You may want to consider a femoral nerve block if you're having an ACL repair. They can give great post-op pain control.

brian
So is there any increased risk of spinal headache in patients who have had one previously? Don't get me wrong, I'm still in favor of general, but I didn't know if the risk changed.


TriBri00

Aug 12, 09 18:27

Post #7 of 70 (12904 views)
Re: Spinal Versus General Anesthesia for knee surgery? [DrPete] [In reply to] Quote | Reply

Not sure if there is an increased risk of a second spinal headache. Most people are so miserable after the first one that they work really hard never to have another. The risk of headache does decline with age, so being older is better.

Brian


DrPete

Aug 12, 09 18:39

Post #8 of 70 (12898 views)
Re: Spinal Versus General Anesthesia for knee surgery? [TriBri00] [In reply to] Quote | Reply

In Reply To:
Not sure if there is an increased risk of a second spinal headache. Most people are so miserable after the first one that they work really hard never to have another. The risk of headache does decline with age, so being older is better.
Cool, thanks. We have a very busy regional team here, so I can't even remember the last case I did under spinal!


Frank Day

Aug 12, 09 19:10

Post #9 of 70 (12885 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

You can also get an epidural. Same as a spinal with zero risk of a spinal headache (unless the Dr. gets a "wet tap" so the overall risk is about the same). Leg block is another alternative if your doctors are skilled at those, not all are. One great thing about spinal or epidural is you can get some spinal narcotics for post op pain which is about as good a pain relief as one can get. I always recommended regional techniques over general techniques when they were a good alternative as they are slightly safer. Once the block is set up you are less dependent on the anesthesiologist - unless he heavily sedates you. He could have a heart attack and you would be just fine.

--------------
Frank,
An original Ironman and the Inventor of PowerCranks


KAT 2 tha izz-O

Aug 12, 09 20:53

Post #10 of 70 (12848 views)
Re: Spinal Versus General Anesthesia for knee surgery? [ggeiger] [In reply to] Quote | Reply

In Reply To:
I did the spinal for both of mine, and it was great. I was actually talking to the doc as he was showing me the IT bands were fine, no unusual wear, etc, and it totally re-assured me that I was not doing damage to my knees by my exercise. He showed me the actual internal things on the screen, while he was in there. I would do it no there way, and if they said they would have to put me out, I'd find another doc. Good luck....it's VERY interesting, and re-assuring, as I mentioned.

x2

Was completely awake and alert the whole time, saw everything asked questions it was great experience. It seems like the risks are less than general in the way it was explained to me. One word of warning when they numb you from the waist down, they numb EVERYTHING from the waist down and feeling returns to your junk way last!!!


Damn you people. Go back to your shanties. -Shooter McGavin


shasta

Aug 13, 09 4:19

Post #11 of 70 (12810 views)
Re: Spinal Versus General Anesthesia for knee surgery? [KAT 2 tha izz-O] [In reply to] Quote | Reply

As another anesthesiologist, I have to completely agree with Brian's thoughts.

A few things to consider (dispel).

1) In healthy "normal" individuals, one form of anesthesia is not necessarily less safe than another form. There are definite reasons why we might opt for one over the other, but that is a case by case basis.

2) The risk of "spinal headaches" is low with both epidurals and spinals (<1%). You never hear about all the people with wonderful spinals, only the one who had a bad experience. A spinal headache is very painful, but also very treatable. In addition, I'm not aware of any data suggesting that having a spinal headache in the past means you're more susceptible to one in the future.

3) We do both general and spinals for knee procedures and a lot of it depends on what the patient is most comfortable with. Some patients don't want to have anything to do with needles, while others don't want to have any level of consciousness. They are both very, very safe, and the anesthesiologist is there with you for the whole procedure regardless.

4) One of the benefits of spinal anesthesia is in avoiding the use of gases and narcotics (like morphine, dilaudid). This can make for a clearer, less nauseous patient post-op (especially for young non-smoking women, who tend to get sick from anesthesia most).

5) Epidurals are pretty uncommon for this type of surgery.

6) Femoral blocks (and other "leg blocks") are usually reserved for bigger knee surgeries (knee replacements etc). Knee arthroscopies are fairly mild and not terribly painful.

7) MOST IMPORTANTLY, If you're anxious at all, you should just talk to the anesthesia group. At the end of the day, the most important thing is that you're comfortable and relaxed going to the hospital and feel confident with your medical team.

FWIW..If I was a patient having a knee arthroscopy, I would probably opt for a spinal...but I just asked my colleague sitting next to me and he would opt for a general anesthetic for himself...go figure!!!

Spinal vs General....it's like HED vs Zipp.....(you get the idea)

Best wishes!! Triathletes and marathoners are our favorite patients. THEY'RE THE HEALTHIEST!

(any other of us anesthesia guys on ST?)


Triman

Aug 13, 09 4:36

Post #12 of 70 (12798 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

If it is just a straight forward knee arthroscopy, ask your Ortho surgeon if he can do it with a local anesthetic injected into the knee and a very small amount of IV sedation (if needed). I do 400-500 of these a year with excellent results. No side affects, no nausea afterwards, and no wait in the recovery room waiting for the spinal or epidural to wear off.

good luck


roubaixman

Aug 13, 09 5:20

Post #13 of 70 (12785 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

Being in the medical field, here's my take: ASK YOUR SURGEON. You don't really want to go outside of his normal routine. Surgeons get used to doing things a certain way and that's when they are at their best. If you start throwing variables into the routine you start introducing more risk. Some surgeons are very comfortable talking to you and showing you what they are doing and answering your questions. Others want you to STFU and let them operate.

If he has no preference, then move on to all the other criteria presented to you.


feman

Aug 13, 09 5:32

Post #14 of 70 (12784 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

This is obviously your choice - but had 7 knee procedures completed over the last 4 years and each was GA. no problem on any of them. Well except that my knee is still Fxxxxx....:-)

Graham

Graham Wilson
USAT Level III Elite Coach
http://www.thewilsongroup.biz


wiffcheese

Aug 13, 09 5:50

Post #15 of 70 (12770 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

In Reply To:
I am going in for arthroscopic surgery in October. It is definitely not my first one (I've had three previous), but in all of my prior knee surgeries, I had a general anesthetic. This one, I have the option to choose.

i am wondering if anyone has had both, and can give me an opinion.

I was sort of intrigued with the spinal, b/c I am the type of person that would get a kick out of watching it (assuming they had a screen), or asking questions...but I don't know what happens with that.

Stuff to consider:

I like to watch :p

I AM a puker with anesthesia.

I have had a spinal tap (and the anesthetic that goes with it)...and the spinal headache made me want to DIE (and I am a veteran of migraines). I was incapacitated for almost a week. Would I be at risk of this with the local/spinal anesthetic? B/c, if so...I will take 12 hours of vomit in a second.

I'm with you on general anesthetics, PUKE MY GUTS OUT. Demoral does the same thing to me which is odd b/c it's supposed to relax you, assuming you need relaxing.

Left knee done in '89 under general and threw up so much I almost turned inside out.

Right knee done in '07, spinal with no Demoral or anything b/f surgery. Felt great and was at home for a nice juicy steak dinner.

My sentiments of general anesthesia and Demoral are: take a hike!


Kikuchiyo

Aug 13, 09 6:00

Post #16 of 70 (12760 views)
Re: Spinal Versus General Anesthesia for knee surgery? [feman] [In reply to] Quote | Reply

Had both my knees scoped under GA with no problem. Just a strong cup of coffee after and I was good to go! :) I can't imagine getting a spinal. Plus I don't want to watch a damn thing. Just get it done and wake me up after.


Alvis

Aug 13, 09 6:42

Post #17 of 70 (12744 views)
Re: Spinal Versus General Anesthesia for knee surgery? [mmrocker13] [In reply to] Quote | Reply

I have had both a general and a spinal for knee surgerys 18 years apart.
(I'm currently recovering from the second one).

I highly recommend the spinal.

I got to see the whole thing, ask questions, and see the problem area. The doctor took me on a tour all around the knee showing me the healthy ACL, the MCL, and good meniscus and the injured parts of the meniscus.Then I watched as he used the various tools to trim and scrape the injured parts. The opperation part only took 30 minutes.

After that you just have to wait to "thaw" out. The bladder is the last part to unfreeze so you go home as soon once you can pee.

Good Luck,
Alvis


mmrocker13

Aug 13, 09 6:44

Post #18 of 70 (12743 views)
Re: Spinal Versus General Anesthesia for knee surgery? [MI_James] [In reply to] Quote | Reply

In Reply To:
I can tell you as a guy that has had a leak from a spinal tap, get the general and have the dr. tape the sugery. There is no cool factor that is worth the risk of a leaking spinal column. I have had no other experience in my life that even would get mentioned in the same discussion as a spinal headache. It is not even close. I would rather file my teeth than get another spinal headache.

Ding ding ding...

I think I have a pretty high pain threshold. But the spinal headache was, without a doubt, the most horrific, terrible, agonizing pain I have ever felt. It was a week's worth of pain and suffering. And I WAS ON VACATION WHEN IT HAPPENED :( Every time I would as much as sit up a bit, it would be so bad, tears would run down my face. Honestly, I would do my own knee surgery with a paring knife before I would have another one of those headaches.

THAT is my fear of having the spinal anesthetic. A repeat of that experience.


mmm-mmm-Momo Charms
Handmade beverage charms, jewelry, and miscellanea

http://momocharms.wordpress.com


ggeiger

Aug 13, 09 7:19

Post #19 of 70 (12732 views)
Re: Spinal Versus General Anesthesia for knee surgery? [KAT 2 tha izz-O] [In reply to] Quote | Reply

In Reply To:
One word of warning when they numb you from the waist down, they numb EVERYTHING from the waist down and feeling returns to your junk way last!!!

Haha. That part I definitely remember! I also had GA on a separate operation a couple of years before my knee, and as a triathlete, I would avoid that at all costs! I came back from 10 days of intense training in the best shape of my life. After the surgery with GA, I was coughing shit out of my lungs for an entire month. I vowed if there every is a choice, no GA for me. Plus the procedure was really interesting to watch.


Frank Day

Aug 13, 09 7:30

Post #20 of 70 (12724 views)
Re: Spinal Versus General Anesthesia for knee surgery? [roubaixman] [In reply to] Quote | Reply

In Reply To:
Being in the medical field, here's my take: ASK YOUR SURGEON. You don't really want to go outside of his normal routine. Surgeons get used to doing things a certain way and that's when they are at their best. If you start throwing variables into the routine you start introducing more risk. Some surgeons are very comfortable talking to you and showing you what they are doing and answering your questions. Others want you to STFU and let them operate.

If he has no preference, then move on to all the other criteria presented to you.
You must be kidding. All the average surgeon wants is the patient to lie still. They know esentially nothing about the various issues associated with the different anesthetic choices. Further, while one choice might be best for me to do it might be the worst for another anesthesiologist if he doesn't have a lot of experience or comfort with the technique. This is a decision that can only be made between the patient and the anesthesiologist. As the OP is finding out, there are no guarantees (good or bad) with any technique.

--------------
Frank,
An original Ironman and the Inventor of PowerCranks


krgregg

Aug 13, 09 8:11

Post #21 of 70 (12716 views)
Re: Spinal Versus General Anesthesia for knee surgery? [Frank Day] [In reply to] Quote | Reply

In Reply To:
In Reply To:
Being in the medical field, here's my take: ASK YOUR SURGEON. You don't really want to go outside of his normal routine. Surgeons get used to doing things a certain way and that's when they are at their best. If you start throwing variables into the routine you start introducing more risk. Some surgeons are very comfortable talking to you and showing you what they are doing and answering your questions. Others want you to STFU and let them operate.

If he has no preference, then move on to all the other criteria presented to you.
You must be kidding. All the average surgeon wants is the patient to lie still. They know esentially nothing about the various issues associated with the different anesthetic choices. Further, while one choice might be best for me to do it might be the worst for another anesthesiologist if he doesn't have a lot of experience or comfort with the technique. This is a decision that can only be made between the patient and the anesthesiologist. As the OP is finding out, there are no guarantees (good or bad) with any technique.
To echo frank - the surgeon isn't the person to ask. ask the anesthesiologist what they would prefer to do - both achieve the same results with different pros/cons, both of which are pretty minimal. you're better off taking what they want to give you, rather than what you want to do. the biggest plus about GA is that you're not frozen for 4 hours and can go home faster.




"Anyone can work hard when they want to; Champions do it when they don't."


Lou

Aug 13, 09 8:43

Post #22 of 70 (12695 views)
Re: Spinal Versus General Anesthesia for knee surgery? [krgregg] [In reply to] Quote | Reply

I would agree with everything Shasta says and would echo Frank's sediments about who you should ask about your anesthetic choice. one of the most common side effects we see from spinals that i would add is urinary retention (you can't pee after surgery). this happens much more frequently in older men (>50).

Working as an anesthesiologist at multiple facilities, i would say that choosing the more common or, dare i say, routine anesthetic choice at that facility is usually best. We don't really offer spinals at our orthopedic surgery center, although i have done them there, but do them regularly at our hospital based practice for orthopedic procedures. it sounds like both are done regularly where you are going so this may not play much of a role. if you really can't decide or aren't really that sure, just have your anesthesiologist decide for you. it's what he/she does every day and will have your best interest in mind.


ggeiger

Aug 13, 09 8:43

Post #23 of 70 (12695 views)
Re: Spinal Versus General Anesthesia for knee surgery? [Frank Day] [In reply to] Quote | Reply

Remember that YOU are the customer. Seems the medical field needs to realize that. I've even seen acupuncture used for anesthesia in brain surgery. Do what YOU want after weighting the options. There are plenty of anesthesiologists around.


TriBri00

Aug 13, 09 10:01

Post #24 of 70 (12680 views)
Re: Spinal Versus General Anesthesia for knee surgery? [ggeiger] [In reply to] Quote | Reply

Alright now I'm mad. Many things in modern life do end-up being that "the customer is always right." Sometimes though we need to respect the opinion of people we choose for their expertise. When I go to my accountant I follow the advice I'm given b/c I trust him and I'm paying for his expertise. When seeking medical care getting a second opinion is always a good idea. What is a bad idea is forcing someone to do something that they're recommending against. If you really think you want a specific procedure/anesthetic, then call ahead and make sure that the anesthesiologist available is able/willing to accommodate you. If you want a spinal/epidural/femoral nerve block and the anesthesiologist that day is telling you no, then there is a reason, maybe related to you or to his/her comfort and expertise with the technique. You wouldn't tell the surgeon how to operate, why would you tell the anesthesiologist what to do.

That said, for the OP, the anesthetic choices are both equally safe but nothing is perfect and everything we do in life has some risk. As triathletes we know that is true when we compete and train.

my 2 cents

Brian


ggeiger

Aug 13, 09 10:12

Post #25 of 70 (12670 views)
Re: Spinal Versus General Anesthesia for knee surgery? [TriBri00] [In reply to] Quote | Reply

Very true. Weight all of the options, but realize there are multiple ones. I sure didn't enjoy coughing up shit for a month after surgery using GA, so if I have any choice, I, personally, would go to lengths to avoid it. Sometimes Docs get so stuck in their rut they don't consider options. That's all I'm pointing out.

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