Can surgery be done under local?

[reallystressedout]

I have gynocomastia / puffy nipples, I can feel the gland tissue. I have it because I was taking medicines that gave me a very high prolactin level a couple of years ago. I only developed it slightly at the time, but since stopping the drug (over the last couple of years) it has now become a real problem. A sort of delayed effect I think.

Several GP's have looked at it, a surgeon hasn't yet.

Problem is I'm terrified of having a general anaesthetic. Partly because I just don't like the idea at all (I'd much rather be awake), and partly because it will be complicated for me due to having to stop taking certain medicines etc.

Can a doctor do this sort of surgery under local anaesthetic? I don't mind being being heavily sedated with tranquilizers, but I just wouldn't like the idea of a general anaesthetic.

I'm wondering if you could give me some views on this? I would be grateful. Thanks.

[Dr. Elliot Jacobs]

For about 99% of patients, local anesthesia is a bad idea.  No matter what your sedation, local anesthesia cannot dull all the nerves that can be set off during liposuction.  It really hurts!!

There is an alternative to general anesthesia and it is something that I use 99% of the time.  It is called "twilight sleep" and it requires an anesthesiologist to administer tiny doses of short acting medications.  You are sleeping gently -- but can be awakened within 5 minutes.  It is far, far preferable to local anesthesia alone.

Dr Jacobs

[reallystressedout]

Thank you for your reply.

I have been reading about twilight anaesthesia, it does seem to me to be preferable. I don't want a general but I really would rather not wake up in pain!

I know it may be hard to say because I guess it depends on a lot of factors but how long is a typical operation recovery time for twilight anaesthesia?

Would it be typical for me to recover the same day and go home or would I need to stay in hospital for a day?

[Dr. Elliot Jacobs]

how long is a typical operation recovery time for twilight anaesthesia?

In my office, typically the patient is awake, alert and lucid within 5 minutes after the operation ends.  We do keep the patient in recovery for 60-120 minutes for observation.  ALL patients are done on an out-patient, ambulatory basis -- there is no hospital overnight stay.

Also, since short and long acting local anesthetics are injected while the patient is asleep, you awaken with absolutely no pain at all.  Some pain does start 4-6 hrs after the patient's surgery has been completed.

And an exciting new drug has just been introduced which I use when a patient requests it.  It is called Exparel and it provides 3 DAYS of pain free recovery.  After 3 days, there is usually no pain in any case.

Your fear of anesthesia is unfortunately overblown.  Many patients say that the anesthesia is the best part of the procedure!

Dr Jacobs

[Litlriki]

Most of my patients go to sleep for the procedure, but their recovery is very similar to what Dr. Jacobs described.  The difference between "twilight sleep" and "general anesthesia" in many cases is slight--with general anesthesia, a device is used to protect the airway (a "Laryngeal Mask Airway" or LMA).  Many of the medications used are the same, just a little more and a little deeper with the general.  I still use tumescent anesthesia, which gives pain relief when the patient wakes up.  In any case, in young, healthy patients, the anesthetic is safer than your ride to and from your surgical procedure!

Rick Silverman