Expert: Ronald Levy, M.D. - 5/4/2008

Question
QUESTION: I am having elbow surgery next week and will have a regional block with
twilight anesthesia.  I've had several orthopedic surgeries so I know what to
expect.  I'm comfortable with twilight because when I had a general for both
shoulder surgeries I got so sick I had to spend 2 nights in the hospital.  

The last times I had shoulder or elbow blocks, they gave me Versed before
administering the block, which I appreciated, because getting the block put
in was uncomfortable.  I was thinking that this time, it would be interesting
to be awake during the surgery -- I'd kind of like to see (or at least hear)
what's going on.  (It's arthroscopic) But I would still like to be sedated
because I don't think I could be that calm even with a block.  Is is possible to
be awake but "happy" during the surgery?  And if I'm given Versed for the
block, will this mean that even though I'm awake for the surgery, I'll forget it
anyway?  (I have always remembered the blocks though even though they
gave me Versed)

How do I stay awake, remember what's going on, yet still have the relaxed
state of mind that I have when they administer the Versed?

ANSWER: As the saying goes, "you can't have your cake and eat it too". Some people can be relaxed with Versed and still awake enough to remember and know what's going on. Others not. To give you enough relaxation for the block, you will probably be too sedated to remember much of the surgery. Of course they can reverse the effects of the Versed but I don't think you want that either. Tell your anesthesiologist what you want and see if he can accomodate your wishes. It never hurts to ask.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Thanks for answering so quickly Dr. Levy.  I really appreciate it.  I have another
quick question.  If Versed is what causes amnesia, then why do I always
remember getting the blocks put in?  Or do they administer more Versed during
the procedure?

Answer
Versed is an amnestic but it doesn't guarantee that you will have amnesia. For most people they don't remember anything, others we give that and some other amnestics and they remember everything. There is no explanation.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston