Expert: Ronald Levy, M.D. - 7/7/2008

Question
Hi-This is a great forum and I appreciate your taking the time to read a question from a layman.  I'm 50 and work as an airline pilot; unfortunately I need to have ulnar nerve/carpal tunnel surgery due to pretty much complete numbness in both hands.  I have (unwisely) avoided any medical cae for my career (ro obvious reasons), but I need to have this surger done, but the problem is the anesthesia.  My surgeon says that he can do it 2 ways: conscious sedation (which I won't do due ot a previous bad experience) and with "regional anesthesia" with or without sedation.  I will only do it without sedation (after meeting with the "contract anesthesia" people from the surgi center, I don't trust them...interestingly enough, neither does my surgeon, except for "regional" anesthesia.  He suiggests a "beer(sp)" block without any other drugs...and says to limit them to a "block only" as neither of us trust them with "conscious sedation"..........my wife, a critical care nurse, says that I'm nuts and suggests a university setting with real anesthesia......i would appreciate your comments........thanks

Answer
You can certainly do it with a Bier block (it can even be done with local anesthesia. There is nothing wrong with mild sedation but if you want to be totally awake, that is OK too (as long as it's is OK with your surgeon). I would say that if you don't trust the anesthesia people at the surgi center, don't do it there. They are the ones who will do the Bier block and if that is done incorrectly, it can potentially be worse than your other fears. If you have the option to do it at a teaching hospital, that might not be a bad idea.

I always tell people "They don't pay me to put you to sleep....they pay me to wake you up!" The anesthesiologist is as important as the surgeon and you need to trust your anesthesiololgist as much as you trust your surgeon.


Ronald Levy, MD
Asociate Professor of Anesthesiology
UTMB-Galveston