Expert: Ronald Levy, M.D. - 11/12/2006

Question
Thanks so much for your fast reply! I've already gotten a copy of my records from the first 2 TURP surgeries at the first hospital to take for the December TURP revision--I very much DO wish to be conscious during this procedure and my urologist said he thought if a spinal didn't work two times, it wouldn't likey do it the third either he didn't think...Do I have other options than a spinal to be awake? Have had same urologist for everyting (who I like and think is great--he's also from TEXAS!)Before I had the second suregery, in the check-in/prep area I explained my spinal failure on surgery one to the nurse doing the IV in me--she said sometimes problems on TALL folks or people who were high-wasted (I'm tall but not hight waisted)--I also heard that taller, slimer folks were ideal candidates for a spinal and at 6 ft 4 in and only 180 that is me.....If a spinal fails, might they try a second stick imediately on that--also I don't know the difference in a spinal and an epidural--do they ever epidurals  for TURP patients?  I appreciate your "volunteer" time to answer questions like this..As a teacher myself (college history) I know the demands on your valuable time.  Thanks  George Terrell Jr  Gadsden Alabama
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The text above is a follow-up to ...

-----Question-----
Hi- I had a TURP August 7th and spinal didn't work. I was sedated but managed to let them know that as resectioning began IT HURT ALOT! They then knocked me out..Had to go in for a revision 3 wks 2 days later and asked for NO sedation till i confirmed I was numb-- 45 minutes of working with me and all they ever got numb were the bottoms of my feet so converted to general.. Can't believe it but have to go in AGAIN for yet another revision/scar tissue removal December 8th...any suggestion on what to tell them this time? (at a DIFFERENT hospital)  I am 6 ft 4 in and 180 weight---is height/weight any kind of a factor for who it rowks on? Are there some folks it just NEVER works on? thanks for any information---- George Terrell Jr.
-----Answer-----
Frankly I am surprised that it didn't work twice! If they performed a good spinal (return of CSF, etc), then it should have worked. Occassionally you may have patches where it doesn't work, or the level is not high enough, but this is very rare with a spinal. Height is a factor in determining the dose. I would reccommend reporting this history to your anesthesiologist at the new hospital (in advance of your surgery) so that he could possibly get a hold of the old records to see what the anesthesiologist wrote. It might be that they will forego the spinal and go straight to general but that will be up to the new anesthesiologist.

Good Luck,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

Answer
If a spinal didn't work, an epidural is less likely as it works indirectly. I would try a spinal after a failed epidural but not the other way around. I don't know what "high-waisted" has to do with anything. I have never heard that term! Other than spinal, there really is nothing else that will reliably keep you out of pain during the procedure other than general anesthesia. Again, I would have a long talk with the anesthesiologist and see what he suggests.

Good Luck,

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston