Expert: Ronald Levy, M.D. - 4/3/2009

Question
Hi-I had surgery on my left arm (ulnar nerve transposistion and carpal tunnel release) several years ago and they did it with a lidocaine (sp?) block with a BP cuff without any other drugs and it went pretty well.  I had one terrible experience with sedation (versed-bad then propofol-worst) for a hernia operation that had to be aborted, and I would never do sedation again.  Now I need identical surgery on the other arm and the surgeon said that she can do it with the same block that I had on the other arm, but at the anesthesia interview, the nurse said that I have to agree to sedation (just in case)-which I would not do since it is unecessary and would be a disaster given my previous experience.  I know that the cuff is uncomfortable, it hurts but is tolerable, the surgeon says patients usually demand sedation, but that the block is plenty.  But the anesthesia nurse says that I have to sign a consent that includes sedation (I would specify block only)......Do I have to do this?  The doc suggested just scheduling the surgery and insisting on a block only on the day of surgery and documenting that.  Seems like the hard way to do it.  Thanks

Answer
Nobody can force you to have a certain anesthetic but by the same token, nobody can force an anesthesiologist to perform an anesthetic they don't agree is the safest. The best thing to do is to tell the preop clinic that you don't wnat sedation and you will speak with the anesthesiologist on the day of surgery. On the day of surgery, explain that you only want the Bier block and if he doesn't agree, is there someone else who will. There is a possibility your case may get cancelled but as I said in the first sentence, each party has the right to do what they feel is safest and correct.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston