Friday, August 06, 2010

insider tip

surgery on the body below the waist can be done under general or regional anaesthesia.

for general anaesthesia, the patient is rendered completely unconscious & largely pain-free till the surgery is complete.

for regional anaesthesia, only the part of the body below the waist is anaesthesised. the patient remain awake but lower body is immobile & pain-free. operations suitable for this technique include C-section, haemorrhoids & lower limb surgery. (read here)

if you are young & healthy, there's not much to choose between the 2 techniques but as the co-existing medical problems like hypertension or diabetes occur with advancing age, it may be (but not necessarily always) safer to have the surgery done under regional anaesthesia. this is largely due to the fact that regional anaesthesia interferes with body function (eg. heart, respiration) to a lesser degree compared to general anaesthesia.

take C-section as an example. everything else being equal, it is inherently safer for the mother to have a regional (in this case, spinal) anaesthesia because it removes the risk of having gastric contents enter the lungs, which is a possible & dangerous outcome if the mother was rendered unconscious by general anaesthesia. besides, being awake at the time of delivery provides the mother with the precious opportunity to hear the baby's cries & be bonded by physical contact.

but here's the deal - very few private doctors will tell their patients that it costs less, up to RM500 & sometimes beyond, to have a spinal instead of general anaesthesia. this is because fewer medication & equipment are required for the former.

so now you know.

PS. however i must put it on record that regional anaesthesia may NOT be appropriate in all operations below the waist. you need to discuss this with your doctor before making a decision.


missyc said...

tks for tip :D
Doc, can u tell : Recently I had what dentist term "mild seizure" after he gave few shots of local anaesthesia for dental treatment. I felt heart beating so fast, couldn't breathe (how to breathe with mouth openwide) then started to tremble.. Two staff hold my trembling hands some covered me with blanket as they thot I was cold ! Dentist asks "Do you have hypertension" yadda yadda.. Yes to that. I thot it was probably the less than 24hrs combination of Painkillers + Xanax + High BP tablet that I experience this ! (lucky it was at IMU so got medical doctor around if not I will be so afraid to go dentist again!)

wenn said...

i remembered my d n c was done under GA..fell asleep immediately n got up easily too.

doc said...


sounds ominous - may have been a complication of the local anaesthetic. it's meant to be injected into the gum tissues but sometimes gains access into some adjacent blood vessels, resulting in a generalised effect rather than a local one.

or, it could just be an innocent anxiety attack.

but what's important is that you're none the worse for it.

doc said...


D&C is a short procedure & nowadays, the general anaesthetic drugs have rapid recovery effects.

stay-at-home mum said...

My lil D has to go for another bone scan in Sept becoz of her medical condition. I am praying that she will be able to keep VERY still for that 30 minutes so that she doesnt have to go under GA again (which she did when she did it when she was a year old). Dont think there are any alternatives in her case, is there?

missyc said...

gone thru local + general anaesthesia.. both bad for me :(

if have to go for future (knee) surgery, probably cannot opt regional anaesthesia, will give the staff anxiety attack instead!

doc said...


if D is co-operative during the procedure, then there's no need for an anaesthetic, save perhaps a light sedative, eg choral hydrate.

otherwise, she may need a GA.

doc said...


the effect of the local anaesthetic you had at the dentist's is different from that of a regional anaesthetic.

unless you're really allergic to lignocaine/bupivercaine, there's no obvious reason why you can't have a spinal for your knee surgery. you can be given a sedative after the spinal anesthetic is done for a pretty good sleep during surgery.

suituapui said...

Would prefer GA, less traumatic...but of course, the doctor knows best.

missyc said...

Had local anaesthesia with sedation for gastro n endoscopy procedure & felt instruments inside one choking one probing & when I woke up had bruises on my arm as the staffs held me coz I struggled !

Still think it's Xanax+painkiller and anaesthesia side effect I experience that sudden wave of fast heartbeat. The medical doctor questioned me as if I misuse or took expired drug. I read that Michael Jackson probable cause of death was related to Xanax and intravenous anaesthesia (was it propofol?) Ya I know... no more Xanax but sometimes it helps :D

doc said...


maybe GA is less traumatic mentally, but if RA is a suitable option, then it's generally safer.

doc said...


xanax is useful as a sedative but it may be unsuitable for some people.

similarly, some patients can tolerate endoscopy well with just a little sedation, while in your case, you obviously had a bit more till you can't remember that you struggled with it!!

zewt said...

well... i chose the right thing then :)

doc said...


everything did go well, didn't it?