Are there alternatives to general anesthesia?
Procedures in the brain, chest and abdomen usually always require general anesthesia. Most other surgical procedures can be done under regional anesthesia. If you are interested, speak to your anesthesiologist prior to the procedure.
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General anesthesia or block?
"General anesthesia" is the term used for drug-induced unconsciousness. A "block" refers to any technique where a local anesthetic, like Novocaine or lidocaine, is injected around a nerve to temporarily "deaden" the nerve and numb the area which that nerve supplies. Spinal or epidural blocks are those which numb several nerves at one time. Axillary (arm pit) blocks numb most of the nerves that go to the arm. There are actually almost fifty different blocks, but only about a dozen are commonly done. Blocks used to be very popular because people wanted to avoid general anesthetics. However, blocks are much less popular today because the drugs that produce general anesthesia are much better, intraoperative monitoring is much better, and anesthesiologists are much better trained; consequently, general anesthesia is much safer than it was several years ago. In addition, every block requires an injection with a needle, and some people simply hate needle sticks.
A block may be the best form of anesthesia for some procedures. For example, prostate surgery done through the urethra is often done with a spinal block. Many hand operations are very successfully done with a block. Many operations, such as chest and brain surgery, cannot be safely done with a block. Other operations can be done with a nerve block, but require a great deal of sedation, sometimes so much sedation that it verges on being a general anesthetic.
Some surgeons simply like the patient to be asleep; others don't care, and still others would rather do some procedures under a block.
If you think you'd be happier with a block, discuss the option with both your surgeon and anesthesiologist. If you do decide on a block, the anesthesiologist will usually be glad to sedate you before and after the block to decrease your anxiety about the needle stick and being awake while the surgery is taking place.
Finally, some blocks, while not being ideal for surgery, can be placed near the end of surgery to provide excellent postoperative pain relief.
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Sedation with local anesthesia infiltration.
Local anesthetic infiltration is the injection of numbing medicine into the area being operated on. Many procedures involving the skin and some deeper procedures can be done in this manner. Most of the sedation is usually given right before the local anesthetic is injected in order to decrease the pain of the injection. Patients who are nervous about being in the operating room can be sedated through the entire procedure.
The surgeon certainly has the best idea of what he or she is going to do and both the patient and anesthesiologist must rely on the surgeon's judgement as to the effectiveness of local infiltration for the procedure
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