To re-jack the thread (re-jack? is that the opposite of hijack?)... The lateral obviously could not be repaired. The arthritis in that compartment is substantial (and why I am not a candidate for really anything other than an eventual DFO). But fingers crossed the medial side is in better shape.

Have you heard, at all, of arthrosurface, or their uniCAP?

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mmm-mmm-Momo Charms
Handmade beverage charms, jewelry, and miscellanea
http://momocharms.wordpress.com

Rock - am not familiar with DFO, arthrosurface or uniCAP. I would take a chance and think the latter might be a half joint replacement. If so, I'd suppose you to be young...or at least young at heart...and you'd put off this type of procedure as long as humanly possible.

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John H. Post, III, MD
Orthopedic Surgeon
Charlottesville, VA

I been out 4 times and I puked only on the last one. It is not a pleasant experience. But I know someone who had three spinals and had one with the horrible headaches afterwards.

If the spinal headaches are anything like concussion headaches, I would choose puking any day of the week.

As a practicing anesthesiologist, I would recommend either an epidural for the anesthetic or a local with sedation if a patient insisted on not having a general anesthetic.
1)The risk of whatever anesthetic you are given is not negligible and regional anesthesia risk may actually be higher.
2) I would only do what the surgeon or anesthesia provider is comfortable doing, some surgeons really don't want to give a play by play when they are working, better to just have it taped and discuss what was discovered later.
3)The problem with a spinal anesthetic, especially as an outpatient is that many times you cannot urinate for a long time after and usually we do not like to dismiss patients until this does happen, in fear of going into bladder retention.
4)Spinal taps are administered using a large needle which also increases (10-20% incidence of spinal headaches), where as spinal anesthetics are administered using a special non cutting and dramatically smaller needles, risk of spinal headaches 1-2/300 cases. I personally have had none in a 14 year career.
5)epidurals work well and the risk of urinary retention is much less..that way you can be awake and aware of what is happening if you are so inclined....that is if a busy OR can support this type of anesthetic.
Good Luck, Mike

They are, at least in my experience, worse. Although from everything I've read here, it sounds like they are not much of a risk with a spinal anesthetic.

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mmm-mmm-Momo Charms
Handmade beverage charms, jewelry, and miscellanea
http://momocharms.wordpress.com

None that you know about anyhow.

Many times the spinal headaches are mild and are usually quite transient anyhow. Those severe enough to need blood patch treatment are quite unusual. Sometimes patients can have mild symptoms that persist for years. I had one patient in my chronic pain practice who was complaining of "migraines" for that had been going on for years. They were worse when he was upright and started sometime after a spinal. A blood patch gave him immediate cure. This had been misdiagnosed for years. Only the obvious one's usually get diagnosed.

Epidural offers no reduced risk for these headaches because the risk of a "wet tap" cannot be made zero and the needle used is much larger such that when one gets a wet tap the risk of symptoms as a result is greater. So, overall risk is about the same between spinal and epidural as I remember.

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Frank,
An original Ironman and the Inventor of PowerCranks

This is probably the real reason spinals/epidurals are not offered very often. The average anesthesiologist is not very good at them, so they take "forever" to perform and they are not done "gently". I did a lot of them as a result of being a pain doc and was extremely good/fast. When asked to do a labor epidural my goal, which I met about 98% of the time was to have the catheter in and pain relief started within one contraction after turning the lady on her side, so less than 2-3 minutes. I never ever asked the patient to fold into a ball, never required any nursing assistance, or anything else to slow things down. For the ladies I also did the blocks at a higher level (T12-L1) than most (L4-5) so the pain relief would start sooner with less injected volume. Most docs are still painting on the betadyne in that time, let alone having the patient draped or starting the procedure.

In the OR I could have the catheter in and the prep started in essentially the same time as anyone else doing a general anesthetic.

People do a lot of unnecessary stuff when doing these and I think it is because it doesn't feel "natural" to them so they want to be extra careful and they think about every step. We had a neurosurgeon who was like that, whatever case he was doing he took three times as long to do anything as anyone else. Seemed like he was being careful but he had a complication rate like nobody else I have ever seen.

So, people don't offer stuff they are not comfortable with and they never get comfortable with it because they don't do it often enough.

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Frank,
An original Ironman and the Inventor of PowerCranks

You know, as I have been thinking about this I should have written up a case report for publication. Opportunity and teaching moment lost. Rats!!!

I always said the most common reason for chronic pain was a missed diagnosis. This was a perfect example. Spinal headache misdiagnosed as migraines.

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Frank,
An original Ironman and the Inventor of PowerCranks

Neither spinal or General! We do 95% under local anesthesia. Intraarticular local anesthetic with minimal sedation. When the procedure is over you sit up, hop off the surgery bed, walk to a lazy boy recliner, go to recovery, get changed, and go home. It's that easy. Surgeons that haven't done it like this will give you 100 reasons why it won't work - nonsense, I've done over 1000 under local anesthesia and it's the only way I'd ever have it done.

Cheers

One question, do you use a tourniquet?

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Frank,
An original Ironman and the Inventor of PowerCranks

No tourniquet since the intraarticular local has epi. Possibly have to inflate the tourniquet 1% of the time because of bleeding. My mixture = 30cc 1% lido + epi and 30cc 0.5% ropiv intraarticular. I use 0.5% lido for port infiltration. Usually 2mg midaz + 50 mcg fentanyl for block (in preop) and then the remaining 50 mcg in the OR. That's it - rarely need propofol.

The issue with most of these arthoscopies is tourniquet pain. And, even that is not necessarily an issue if the tourniquet is up for less than 30 minutes or so. So, I would agree with you, no need for anything other than local. Do you have an anesthetist stand-by, just in case you need something or do you go "bare".

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Frank,
An original Ironman and the Inventor of PowerCranks

I've had the same issues with general anesthesia and vomiting. Request that the anesthesiologist give you something for your nausea before you even wake up.

Just had the knee surgery Friday 10/2. I selected the spinal. Recovery was fast. No sick feeling only had to wait for my legs to wake up. Would select the same approach again if I had to do it again. (let's hope not). Good Luck.

I have a question for which I can't find an answer . I have had two spinal fusions in my lumbar area. I have been told that the cement which holds the fusion is not as porous as my other bones. Can any one tell me if this is true. I want to have a spinal block in order that I have a total knee replacement. I do not trust the anesthesiologist She says she can't put a needle in my lower back. She had no X-rays.
She won't even try.

Related question...I had surgery to fix a fx in my hand (screws) last spring. Had GA. Once home that day, became super nauseous.
Just curious, if I ever need GA again, are there ways to avoid the nausea? (I hated it!)

Trust you anesthesiologist. You've had two spinal fusions in the lumbar area and chances are you've had them where we would want to put the spinal. The chance of success is poor to be able to succesfully get into the intrathecal space. Who else are you going to trust? X-rays don't provide much data since we do the spinals without fluoroscopy. I know that I wouldn't be excited sticking a needle into an area that's been operated before let alone twice. Anestheisologists are the ones that are sticking the needle into your back and are the ones that administer the anesthetic, I think they know what they are talking about. If I were you, I would go with what your physician recommends. Have a general anesthetic and request a femoral nerve block as well.

Nausea from the anesthetic usually happens pretty much immediately after the anesthetic. Most people get anti nausea medications as part of the general anesthetic. However, if you are prone to it, we can make some changes to try to reduce the incidence of nausea but unfortunately, you are a higher risk case of nausea no matter what we do. I'm the same and get nauseaus on anesthetics and narcotics. If possible, I have had my surgeries with local only. I've got to be honest with you that most people probably wouldn't be okay being totally awake during surgeries. Most surgeons don't like a completely awake patient. So I would do what your surgeon and anesthesiologist feels comfortable with. It's a little easier for me to swing this since I am an anestheisologist, and can handpick my surgeon and anesthesiologist most of the time.

I can tell you though, that only a few of my colleagues (surgeon and anestheisologists) were willing to do my case with me having no sedation and just having a block.

I do have to say that you've got to be pretty motivated to do this. When I had a plate put into my wrist last year, it was interesting hearing the bone being drilled and feeling the tugging as they exposed my distal radius fracture. Your mind plays tricks with you when you've got your arm blocked...you know your arm is there but your brain can't comprehend the lack of sensory input. I went to college with my hand surgeon so he was totally comfortable with me being awake. But if he didn't feel comfortable, I would have gone asleep.

Of course I couldn't resist at the beginning of surgery playing a trick on my colleagues by yelling when incision was made. Caused everyone to freak for a second but definitely broke the tension in the room since they were operating on a friend.

>>>>> nauseaus on anesthetics and narcotics <<<<<

The nausea did not hit me until I was home for a while. Perhaps it was the narcotics? I know, in other circumstances, I have been given pain killers to take at home and after taking one I stopped due to nausea (went to ibuprofen).