Expert: JM Starkman, MD - 9/3/2009

Question
Dr Starkman,

I am anticipating having breast reduction/abdominoplasty within the next 6 months. In preparation for the surgery, I have consulted with 4 plastic surgeons.

The concern that I have is with the type of anesthesia used by the surgeon I prefer, regional block with sedation. What is your opinion of this type of anesthesia for this surgery? The rest of the surgeons I consulted with all use general anesthesia. Is a regional with sedation generally an accepted form? Are there benefits and disadvantages that you can point out to me?

Also, would the fact that I have had a microdiscectomy 4 years ago pose a problem in administering this type of anesthesia? I do not have any hardware in my back. Just a staright-forward microdiscectomy at L4-L5.

Thank-you,
Lee

Answer
Your diskectomy surgery should not pose a problem.

A regional block with sedation for both reduction surgery AND abdominoplasty will require considerable amounts of both local anesthesia and sedative.......along with the potential complications of both (prolonged effect of sedative, toxic local anesthetic blood levels, longer time to ambulate, for example).  This would not apply to a high epidural anesthetic though----is this what you mean by 'regional'?  Many abdominoplasties require abdominal wall muscle work as well as "fat" surgery.....local anesthesia and sedation will not provide adequate muscle relaxation for this type of surgery if that's what your surgeon needs.

You've obviously given careful thought and planning to your surgery, having evaluated your options with four different surgeons. Now, considering the details of your anesthetic during that surgery--here's what I'D mandate:  

1. A board-certified anesthesiologist makes the anesthesia decisions/ does the anesthesia.
2. You meet and agree with him prior to surgery.
3. General anesthesia. (properly conducted general anesthesia today utilizes short-acting agents and analgesics that will have you awake, comfortable and ready for discharge within an hour after awakening.
4. Oral pain medications for the first day or so postoperatively.