peridural / epidural or general anesthesia?

[kazmahp]

Hi Doc's!

Thanks for creating this board and helping all of us out here. I finally got the courage to get my gynecomastia surgery scheduled and I'm also getting some lipo work done on the flanks and hips. Total surgery time should be around 3-4 hours.

I always assumed I would be getting general anesthesia, but the anesthesiologist today recommended epidural anesthesia instead. She said she will still keep me sedated so I wont know what is going on with epidural, but if she wants she can turn off the IV drip and have me recover within a few minutes if she wants me to move on my side or something. The anesthesiologist also mentioned with epidural I will have something stuck into my spine but that is still a lot better than general since general anesthesia basically paralyzes you but with epidural you breathe on your own.

I'm 29 and 185 pounds and am fit enough to undergo either procedure. From what she was saying it sounds like epidural with sedation sounds like a better option compared to general anesthesia, but I can't find anyone else on this board recommending it.

What do you doc's think? Do you prefer general or epidural anesthesia with sedation for your procedures?

She said she's board certified and has tons of epidurals for liposuction and thinks its the better option for me. So, as you can tell I'm pretty confused right now.


Thanks again for all your good work!

[Dr. Cruise]

Any time I operate on more than one area on the body, I use and would recommend general anesthesia. It doesn't seem like there would be much advantage to use epidural for surgery where significan part of it takes place on your chest and not the legs.

[kazmahp]

Also is epidural with sedation considered "twlight sleep" anesthesia that Dr. Bermant prefers. I've found some posts here recommending "twlight sleep" or "IV sedation" over General Anesthesia, but I'm still uncertain whether epidural with sedation is considered the same thing or not.

[Dr. Elliot Jacobs]

Epidural anesthesia is an injection into the area of the back surrounding the nerves.  It is generally used to anesthetize the lower half of the body (as would be required for you to have lipo done on your abdomen or thighs) -- I have absolutely NEVER heard of it being used for gyne or other chest or breast work alone. 

General anesthesia or intravenous sedation (twilight sleep) are the two most commonly used methods of anesthesia for gyne surgery alone. 

If you are having gyne surgery plus lipo of abdomen and flanks, then epidural plus intravenous sedation is a reasonable and acceptable anesthetic approach.  The epidural would anesthetize the lower half of your body but you would still need local anesthetic and sedation to take care of the gyne portion of the operation.

Dr Jacobs

[kazmahp]

Thanks Dr. Cruise and Dr. Jacobs for answering my question.

The anesthesiologist did say I would be getting epidural+sedation (not just epidural itself). She considers it slightly superior to General Anesthesia.

I guess the only questions I still have left are if I do indeed up going with epidural+sedation

1. Will I "feel" anything during the surgery?
2. Will be conscious, unconscious or in a dreamlike state?
3. Will I have any memory of the procedure
4. Can they make me unconscious (sedate me) before they put the epidural block in my spine?


I'll ask these questions to my anesthesiologist when I next talk to her on Tuesday, but if anybody wants to please feel free to give me your opinion.


I'm so excited to change my life. I'm exactly 7 days away from surgery and keep asking myself how come I never got the courage to do this earlier. i've known about the surgery for a while, but trust me reading people's experiences on this board made me feel a lot more confident to go ahead and finally get this taken care of.

[Dr. Elliot Jacobs]

Good questions -- here are the answers:

No, you will not feel anything or be aware of anything or be aware of the passage of time during the procedure.  You will be sleeping gently and comfortably, breathing on your own and will have absolutely no memory whatsoever of the entire procedure.  You will awaken after surgery and will ask one question: "When are you starting?" and the answer will be "We are finished!"

As for the epidural itself, you may receive some slight sedative but the anesthesiologist needs you to be awake and your verbal input to assess the amount of and level (ie thighs, mid-abdomen, or higher) of the epidural anesthesia.  Once he knows the level, then you will be further sedated.

Good luck with your procedure!!!

Dr Jacobs

[DrBermant]

Hi Doc's!

Thanks for creating this board and helping all of us out here. I finally got the courage to get my gynecomastia surgery scheduled and I'm also getting some lipo work done on the flanks and hips. Total surgery time should be around 3-4 hours.

I always assumed I would be getting general anesthesia, but the anesthesiologist today recommended epidural anesthesia instead. She said she will still keep me sedated so I wont know what is going on with epidural, but if she wants she can turn off the IV drip and have me recover within a few minutes if she wants me to move on my side or something. The anesthesiologist also mentioned with epidural I will have something stuck into my spine but that is still a lot better than general since general anesthesia basically paralyzes you but with epidural you breathe on your own.

I'm 29 and 185 pounds and am fit enough to undergo either procedure. From what she was saying it sounds like epidural with sedation sounds like a better option compared to general anesthesia, but I can't find anyone else on this board recommending it.

What do you doc's think? Do you prefer general or epidural anesthesia with sedation for your procedures?

She said she's board certified and has tons of epidurals for liposuction and thinks its the better option for me. So, as you can tell I'm pretty confused right now.


Thanks again for all your good work!

Epidural Anesthesia involves placing numbing medication just next to the spinal cord in the back and just does not make any sense to me at all for Male Chest Abdomen and Love Handles.  I saw many operations in China where very high epidural anesthesia was used for blocking chest surgery.  It was cheap, much cheaper than general or sedation, but  blocks that high tend to knock out a patient's ability to breath, so they were intubated (a tube put into their airway to help them breath.)  I remember the Chinese patients yelling at the surgeons during the operation with the block not being adequate.  To use an epidural block for the lower body and sedation and local for the upper also makes no sense.  I can perform an entire full Tumescent Tummy Tuck Abdominoplasty under my tumescent local anesthesia with sedation alone. No epidural. No added risks.  This surgery involves much more than just liposuction and if I can have comfort levels before, during, and after surgery without such added blocks then the real question is Why Add the Epidural Block?  You can learn more about the Comfort after Tumescent Tummy Tuck here.

An epidural block can be used to keep a patient comfortable through an inadequate Tumescent Anesthesia, but such patients without an adequate tumescent block tend to have much more swelling, bruising, and discomfort after surgery.  If there is adequate tumescence, what is the added advantage to the block?  I can not think of any.

If I was the patient, I would want to know more, see early after surgery pictures to see that doctor's Bruising and Swelling After Surgery, and learn more about their Patient Comfort After Surgery: how much pain medication patients needed and what their Recovery After Surgery was like.  Each doctor has their own comfort levels of what they offer.  Learning what that results in can be a powerful advantage!

Good luck on your surgery.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Dr. Elliot Jacobs]

I agree with Dr Bermant. 

I wouldn't argue with epidural plus sedation, but I do not use epidural in my practice -- and I do a lot of gyne surgery plus abdominal and love handles lipo.

Epidural anesthesia is really terrific for lower body lipo -- such as on the thighs, knees, etc.  If you have a good anesthesiologist who can sedate the patient plus a good surgeon who can administer local/regional anesthesia plus tumescent anesthesia, there is really no need for an epidural for any work above the level of the groin.

Dr Jacobs

[kazmahp]

Oh wow now I'm completely confused. The anesthesiologist made it pretty clear that it was epidural+sedation (not just epidural by itself), but as you guys have suggested if just sedation will do, why would she be adding epidural to it as well.

I'll ask her more when I next talk to her, but since none of you guys use epidural I'm now leaning towards General Anesthesia.

[Dr. Elliot Jacobs]

Didn't mean to confuse you.  Epidural plus sedation is perfectly acceptable.  There are lots of ways to accomplish the same result.  General anesthesia is also acceptable.

What Dr Bermant and I have suggested that in our practices, neither epidural nor general anesthesia is necessary to accomplish our goals.  When you have an expert anesthesiologist who can administer just the right amount of IV sedation, and then a surgeon who can expertly inject appropriate local anesthetics and tumescent solution, then one can do both gyne and abdominal/flank lipo without either epidural or general anesthetic.  That indeed is what I do in my practice.

The nice thing about this type of anesthetic is that when the last stitch goes in, the patient is awake, talking, lucid, and can get up and walk out of the operating room (which he would not be able to do with epidural).

Dr Jacobs

[kazmahp]

Thanks Doc, that makes sense. I'll ask her why she can't just to sedation and needs to add epidural.

I wish you guys were in Seattle. It would have made this a whole lot easier!

[DrBermant]

Thanks Doc, that makes sense. I'll ask her why she can't just to sedation and needs to add epidural.

I wish you guys were in Seattle. It would have made this a whole lot easier!

Actually, I see many patients from Washington State and around the world who prefer my technique for Gynecomastia Surgery.  Here is another patient from Washington State who came for my Revision Gynecomastia Surgery.

To minimize travel, they usually start out with our Preliminary Remote Discussion.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction

[Dr. Elliot Jacobs]

And I also offer an email evaluation -- at no charge.  If you wish, send me a PM with your email and name.

Whatever you decide, best of luck with your procedure -- I am sure you will very happy once you have rid yourself of the gyne.

Dr Jacobs