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GA or Epidural with or without sedation?

Discussion in 'Hip Replacement Pre-Op Area' started by Gum168, Nov 28, 2013.

  1. Gum168

    Gum168 Member

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    OK, so I had my pre admission check and hip class today. Although it's settled a lot of my questions, it has raised another about anaesthesia. I understand the differences with regards to risks etc but I'd really appreciate reading other people's experiences.

    Did you have GA or Epidural and if Epidural, with or without sedation? I'm especially interested to hear about non sedated Epidural. I'm dead nosey, and (assuming the anaesthetist thinks I'm suitable of course) I'm wondering if I can manage non sedated Epidural. Apparently there will be someone with me on my side of the screen at all times and I can have music through headphones if I want. But the question is, can I cope with the equipment noises? Not sure if this will be possible, but I'm thinking about trying it, so long as I can ask for sedation if it gets a bit much. I was very anxious about Epidural because a friend of mine had one 15 yrs ago to have her last baby and she had problems, couldn't walk for about 5 days, massive headache, she didn't want much to do with her daughter initially because of it all. Was OK in the end, but it put me off. 15 years is a long time in science and medicine so it's probably not like that now and I'm starting to get over this fear. So I'd appreciate any input about the Epidural.

    I really like the idea of no post GA hangover for several days, and just generally feeling like myself so soon after again. And I like the lower DVT risk.

    Anyone with experience of both GA and Epidural? One for each side? How did they compare? Would you do Epidural again? And I'd especially like to hear from anyone who had non sedated Epidural. What was it like? How did you feel after?

    Thanks in advance for all replies.

    Kim



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  2. Butterfly

    Butterfly Post-Grad

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    I had the spinal with sedation (not sure about difference between spinal and epidural). The anesthesiologist told me going in the the spinal is what both he and the surgeon prefer, because it has much fewer risks, and that it is miles away from what it was even a few years ago. I had no problems at all with the spinal for either hip and had no post anesthesia nausea or headaches or anything. I don't think you should be araid of the "with sedation" part. It was almost instant, and you come right out of it as clear headed as can be, considering all the pain meds you'll have on board. I'd totally recommend the spinal with sedation. I would have panicked if I'd been aware of what was going on, even if I couldn't feel anything. Do the spinal with sedation, would be my advice.

    Peace and love.
  3. Tykey

    Tykey Forum Advisor

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    Epidurals aren't normally used in the UK, I suspect he really meant you would have a spinal, which isn't an epidural. I'd establish this point before you think any more. There should be an article in the library section which explains the difference, a spinal is far less a problem than an epidural. All you know about it is that your legs will have no pain (or feeling) for a few short hours while the traditional painkillers are starting working for you.
    As for staying awake, good luck with that one, because I wanted to stay awake and watch, but off to sleep I went to wake up about an hour later feeling absolutely tremendously well and calm. If it worries you to risk staying awake, just ask the anaesthetist to make sure you aren't.
    NO after effects of the spinal, which is why they use it, as it gives you a much better start to recovery.
    Please don't worry, compared to what you imagine, it's a non-event!
    My second knee is just beginning to collapse, and when it's time they will use anything else over my dead body.
  4. Hoppy Nanny

    Hoppy Nanny Post-Grad

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    Had the spinal block ( it's not an epidural)... WITH sedation.... It was marvellous.... Didn't feel a thing.... Not sure I could cope with no sedation though... You sound braver than me.... The op was so much easier than I thought... Was up and about walking by 6pm.... Highly recommend it! X


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  5. Gum168

    Gum168 Member

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    Thanks everyone for the replies. I slept the best I have since the date was decided last night. I'm so much happier and settled having more detail now.

    Tykey. I've just checked the booklet I was given (Spire Healthcare - Hip replacement and resurfacing, it might be online somewhere to view), and it says "Your anaesthetist may give you an epidural or a spinal injection. For an epidural, the medicine can be topped up through a fine plastic tube (cannula). A spinal injection is a one off injection." I was asking loads of questions and the epidural is the one most used, because they rarely use the morphine PCA pump now, it's been largely been replaced by an epidural PCA pump (patient controlled analgesia). This is a Spire hospital, which is a private hospital group in the UK, so I'm not sure what the NHS does, but that's definitely the one they were telling me about. At that hospital it's about 50/50 GA and epidural.

    After reading the replies, here and on my other thread, I think if they offer me epidural with sedation, that's the one I'll go for. I'm really curious and would like to be "around" as it were while they modify what is after all My body, but all things considered, maybe sedated would be better. I'm glad to read that i should be pretty alert as soon as it's over. I don't even drink much alcohol because I don't like wooziness and prefer a sharp clear head. Thanks Butterfly for reasuring me about that.

    Thanks everyone, the info was useful in helping me make up my mind.

    Kim
  6. Gum168

    Gum168 Member

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    Just saw Hoppy Nanny's reply, thanks for that also. It's not that I'm brave, I'm just dead nosey and I like to know exactly what's happening to my own body. Haha. I think hubby thinks I'm a bit control freakish about it, but I'm the one who has to live with the consequences forever, unlike the medical team who have a very fleeting acquaintance with it, so I find myself slightly unnerved about handing my body over, totally unconscious, to someone else. I think it involves a huge amount of trust.

    Kim.
  7. Littlejem

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    Hi I had a spinal, privately through a BMI healthcare hospital. It felt really weird when they turned me on my back and then lifted my legs, I could see the legs but they couldn't be mine, I couldn't feel a thing, a really weird sensation and it made me chuckle!! I'd had GAs for previous major surgeries but had both my hips done with the spinal and sedation and felt wonderful when I woke up, so much better than a GA!! I was scared stiff of waking and the anaethetist had told me that it could happen because they don't heavily sedate but if I did, I'd never remember and he was spot on!!! Have you watched a video of the surgery, I wouldn't recommend it but maybe you could just listen and that would give you an insight to how it might feel to be awake? Not for me but if you are curious........... :umm:
  8. Gum168

    Gum168 Member

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    Ah Littlejem, yes I watched a video of the whole thing online a few days ago. I'm no longer working in a science environment, but I was a biomedical scientist back in the day, and anything like this fascinates me. I didn't faint when watching an operation or when watching an autopsy, I have a strong stomach for it all. I felt better after watching the video, fear of the unknown is worse for me, my imagination is much more gory than the reality. I was surprised to see how clean it was in reality. No where near as messy or bloody as I had imagined, I couldn't imagine how the internal stitches could pull it all back together neatly, but now I've seen it, I don't have to worry about that, I know how it all goes nicely back into place. Maybe it is my science background that makes me want so much detail, I don't know, but I am a bit nerdy at times. The more info I have, the better I feel. Its definitely not for everyone though.
  9. Gum168

    Gum168 Member

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    Hang on a minute, if you had sedation, how did you see the legs bit? Do you remember much? Its not the all of it I'm concerned about, but I have to say the noise of the cutting and drilling might make me freak a bit because it's my bone! It's not the same as watching someone else's. The rest of it, I'd love to be able to see with a mirror or screen. You see, I'm just plain nosey!

    Kim
  10. Jaycey

    Jaycey Moderator

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    I have had GA and spinal with sedation and without a doubt spinal with sedation is the way to go. It took me days to get over GA after my spinal decompression surgery. Mind you I was one of the weird patients who woke up during the THR. I would suggest you specify that you do not want to wake up or hear anything. This surgery is major carpentry and very noisy. You won't feel a thing but the noise did bother me. I should have specified and they would have given me the happy juice earlier.

    Here's the thread Tykey was telling you about Anaesthetics - spinals, femoral blocks, GAs and everything else
  11. Toothfairy

    Toothfairy Post-Grad

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    Hi Gum168,
    I had both my TKR's done this year with spinal and no sedation.
    I could hear the noises but as I knew to expect that I was fine with it. I could also feel some pulling and tugging but no pain at all.
    Both times the anaesthetist was prepared to give me sedation at any point if I changed my mind but I was just fine.
    I had the first one done in an NHS hospital and the second one done in a Spire hospital. Both experiences were good.
    Good luck whatever you decide,
    Toothfairy x
  12. Gum168

    Gum168 Member

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    Ooh Toothfairy, tell me more. We're you bored? Did it feel like a really long time? Did you listen to music? Did someone talk to you?

    Sorry for all the questions. If I can be brave enough I'd prefer no sedation, I like a clear head.

    Kim


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  13. tek'smom

    tek'smom Junior Member

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    I started with an epidural and ended up with the epidural and GA. I didn't hear or feel anything and had no problems afterwards.
  14. Jaycey

    Jaycey Moderator

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    Kim, you will have a clear head after the sedation. That's why the recovery from it is so much easier!
  15. Tykey

    Tykey Forum Advisor

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    Sedation isn't really a good way of describing what they give you. Call it happy juice and it won't seem like an issue, as you wake up all smiley with clear head just desperate to get out of bed and start the recovery.
  16. Toothfairy

    Toothfairy Post-Grad

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    Hello Gum168
    My two experiences were different. During the first one the anaesthetist talked to me to check I was ok occasionally and everyone else just got on with their jobs. I am sure the anaesthetist wasn't far away but he was out of my line of site so it was a little but lonely. It didn't seem too long as I could see a clock and keep and eye on the time and I was paying attention to what was going on.
    The second time the anaesthetist was very attentive and chatted away to me. The surgeon talked to me too and some of the others. Everyone was very attentive and we laughed and chatted away.
    The first one wasn't a problem, just very business like but it didn't put me off doing it again.
    I didn't listen to music and didn't think of it so I didn't ask.
    I was very calm and found it all fine.
    The reason I didn't want sedation was that I had had it before and hadn't found it worked well for me. Admittedly it had been many years previously but I felt able to manage without.
    Both times I had the option of telling the anaesthetist at any time if I wanted to change my mind.
    Like you I would have liked to watch but I couldn't see much because of the drapes.
    Good luck whatever you decide.
    Remember you don't have to make a final decision till the last minute. You could always decide to try without sedation if that is what you think will suit and then change your mind if you don't like it. Hope that helps.
    Toothfairy x
  17. Gum168

    Gum168 Member

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    Thanks everyone. Ok, I'm going to stop obsessing about this. If they offer Epidural or spinal I'll take it with sedation. That sounds the best.

    Thanks for the advice. I knew this would be the best place to ask.

    Kim

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  18. Gum168

    Gum168 Member

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    Just saw Toothfairy 's reply. I may try without if I am assured I can take the sedation if I need it. Either way, I'm definitely Happy with Epidural or spinal. I would very happily watch on a screen, it really is the electrical appliances part that I'm worried I might react to, even if I'd been calm up to then.

    Thinking about it, I suspect this might depend on how I take to the anaesthetist on the day.

    Kim

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  19. Gum168

    Gum168 Member

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    Thanks Jaycey. I'm fairly settled now about having the epidural with sedation. I was scared of it before, but it sounds like things have moved on a lot and I've not been hearing any horror stories about any recent procedures, quite the opposite in fact. Thanks everyone. Its been very reassuring.

    I've been reading through various pre-op and post op stories, it all sounds pretty good. I have to say though, there's nothing like asking questions in person, of the people who will be involved in your care when it happens. It's made all the difference to me.
  20. Poppet

    Poppet Honourary Moderator

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    Hi there Gum168 sorry a bit late to this discussion.... I don't think you will be disappointed with your decision.. I opted for a spinal with a light GA, which is the way they give it here in Australia, and wouldn't hesitate again -

    Most joint replacement surgeries use either general or regional anesthesia. General anesthesia affects your entire body. It acts on the brain and nervous system, leaving you in a deep sleep. Usually, it is given by injection or inhalation.

    Regional Anesthesia
    Regional anesthesia involves numbing a specific area of the body, without affecting your brain or breathing. Because you remain conscious, you will be given sedatives to relax you and put you in a light sleep. I said to my anesthetist... 'Don't want to hear, see or smell anything" he was wonderful and took very good care of me - anesthetist are very specialized.

    The two types of regional anesthesia used most frequently in joint replacement surgery are spinal blocks and epidural blocks. For surgery below the hip, a combination block that targets the lumbar plexus and the sciatic nerve can numb only one leg.

    Spinal Block
    In a spinal block, the anesthesia is injected into the fluid surrounding the spinal cord in the lower part of your back. This produces a rapid numbing effect that can last for hours, depending on the drug used.

    Epidural Block
    An epidural block uses a small tube (catheter) inserted in your lower back to deliver large quantities of local anesthetics over a longer time period. The epidural block and the spinal block are administered in a very similar location; however, the epidural catheter is placed slightly closer to the skin and farther from the spinal cord

    There are several advantages to using a regional anesthesia during hip or knee replacement surgery. Studies have shown that there is less blood loss during the surgery, and fewer complications from blood clotting afterwards.

    Good luck, I look forward to following your journey :)

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