Patients stay awake during surgery, minimizing pain

Mary McIlvenna thought “spinals” were just for Caesarean sections, so when an anesthetist asked her if she would like one instead of general anesthesia for her ankle surgery, the Scarborough woman was a little surprised. “I had never heard of that before for other surgeries,” says McIlvenna, who underwent surgery last month at The Scarborough Hospital to repair her broken ankle caused by slipping on the ice.

But the pros sounded good: spinal anesthesia, like other types of regional anesthesia, last longer than surgery, providing pain relief hours after an operation; pain medication can be added during freezing, reducing the medication required post-surgery; patients avoid nausea and vomiting common with general anesthesia; and fears about general anesthesia are eliminated.

McIlvenna – who for three decades has gone dancing three times a week with her husband of 58 years – was a little nervous about a needle in her back, but says she is glad she chose the spinal anesthesia. And although she remained awake for the first part of her surgery, McIlvenna felt no pain. As the surgery progressed, she chose to sleep, with the help of sedatives.

“For the most part, patients assume they require general anesthesia and must sleep during surgery. However, in some cases it is safer for the patient to remain awake,” says Dr. John Oyston, Chief of Anesthesiology at The Scarborough Hospital, General campus.

Regional anesthesia is the blocking of nerve supply to part of the body so the patient can not feel pain in that area and allows a patient to remain awake. A combination of regional anesthesia – like an epidural or spinal – and sedatives can spare a patient general anesthesia and the memory of the surgery.

“It is not for everyone,” says Oyston, adding many are not comfortable hearing cutting and other noises during surgery. “We don’t try to talk people into it, but some patients enjoy being awake during surgery.”

Joan Emmans is one of those people. “I was dreading general anesthesia,” she says. So when she asked Oyston if there were any alternatives, she was relieved when he told her she could have regional anesthesia. “I didn’t know that was an option,” says the college instructor who was concerned about feeling ill after surgery as she had in the past.

So Emmans, 59, chose regional anesthesia when she had surgery on her feet in December at The Scarborough Hospital. She also decided not to have any sedation. Throughout the surgery she chatted with doctors. “Had they had a screen on the ceiling, I would have loved to watch it,” she says. “You can’t feel it so there’s a real disconnect.”

Recovery was fast. She was pain-free and felt alert when the surgery was over. “I think it should be presented as an option to patients when it can be,” she says. “I am pleased I did it this way.” But because anesthetists see only 10 to 15 per cent of their patients prior to surgery day, Oyston says the option of regional anesthesia is not known to many.

Stan Thompson had heard of regional anesthesia for surgery, but did not know if he was a candidate for his hip replacement. So when his orthopedic surgeon presented the alternatives to general anesthesia, Thompson, 63, was thrilled. He admits he was a little leery of being “completely knocked out” and was concerned about managing the pain after surgery. “It was a consultative process. I felt like I was in control. I was informed. I wasn’t told what to do,” says the police officer turned high school safety monitor.

Thompson chose regional anesthesia with some sedation and was pain-free after surgery. “The spinal (anesthesia) wears off gradually so it is not like a general where you wake up in pain,” he says. Thompson attributes his speedy recovery and minimal pain to regional anesthesia. “I’d highly recommend it. It was a very positive experience,” he says.

All three patients say their post-surgery pain was minimized and they would chose regional anesthesia again. “Other good candidates for regional anesthesia include patients undergoing hernia repair, hip and knee replacements and foot surgery,” Oyston says. “We don’t talk it up as much as we should. Patients who have had it once usually ask for it again.”