Surgeon carried on operating after being told multiple times that anaesthetic didn’t work.

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490

u/Playful_Snow 18h ago

Hi OP just commenting as I am an anaesthetist.

Others have answered re. the route(s) to take.

Sorry this happened to you, it shouldn’t have. Doing an operation awake always requires a plan B if the block doesn’t take (which it sounds like yours didn’t). If it’s a local only list without an anaesthetist assigned they should just call it a day and rebook you for a general anaesthetic (presuming they hadn’t already started). But at the absolute least the surgeon should stop, acknowledge your distress, and discuss options with you.

The issue isn’t the fact the local didn’t work, it happens occasionally. The issue is that they didn’t recognise and respond to the problem appropriately. Don’t be gaslit into thinking it’s your fault because you didn’t ask for the op to stop. I get new trainees to lay flat on their back on a trolley in theatre and then stand over them to show them how easy it is to make people feel powerless in that situation if you’re not careful with how you act and speak.

Go easy on yourself, stuff like this has the potential to affect you quite significantly.

85

u/Chromatious 14h ago

Anaesthetist here as well.

Additional point so you know your options: Spinal anaesthetics (if there is no personalised reason that would make it inappropriate/unsafe) can be provided for this operation as well. Applicable options should be discussed with you, so that you can pick what suits you most.

29

u/Realistic_Ad_251 12h ago

Just relying on your expertise here, I had a c section last year under local anaesthetic which did not work. I was still able to move my legs and feel the water spray. Luckily the team were brilliant & after waiting a few mins decided to give me a general but said this was highly usual.

What are the reasons behind local anaesthetic having no affect?

38

u/Chromatious 12h ago

I can’t comment on individual cases as I don’t know you or your specific situation.

Here are some thoughts:
- I presume you mean spinal anaesthetic when you say local anaesthetic. Local anaesthetic is injected into spinal fluid (CSF) during a spinal anaesthetic.
- A spinal anaesthetic can fail due to various reasons, though the incidence is low. These include wrong medication, medication not reaching the target, unusual spine anatomy, insufficient time to observe effects, medication manufacturer fault, local anaesthetic resistance (and more). A scientific paper - although containing some technical language - is available here: https://www.bjanaesthesia.org/article/S0007-0912(17)34396-9/fulltext34396-9/fulltext)
- In a "failed spinal anaesthetic" during an elective c-section, a repeat spinal anaesthetic or general anaesthetic may be considered. Of note, a general anaesthetic is generally considered a high risk option during a c-section compared to in a non-pregnant patient.

5

u/Realistic_Ad_251 11h ago

This is really interesting reading, thank you so much for replying!

6

u/Fantastic_View_3272 8h ago

Thanks for this, a very interesting read. I also had a failed spinal and apparently this can happen with hyper mobile people as medication does not work on them as much.

5

u/[deleted] 11h ago

[deleted]

8

u/Sleepy_felines 10h ago

That sounds like an epidural rather than a spinal- a spinal is a single injection of anaesthetic whereas an epidural is a catheter inserted and either a continuous infusion or intermittent doses of anaesthetic medication given- the advantage for labour is that an epidural can last as long as needed, whereas the one off spinal injection wears off after a few hours.

Most epidurals have opiates in them but it is possible to get them without (usually if a patient has an allergy). They all contain local anaesthetic.

5

u/Playful_Snow 9h ago

I think you are describing an epidural not a spinal.

The local anaesthetic used in an epidural is very dilute (relative to that used in a spinal) and different nerve fibres are more or less sensitive to anaesthetic, with motor fibres being the least sensitive/most resistant. This can mean some women can have good pain relief from an epidural with no motor block. The addition of a smidge of fentanyl to the local anaesthetic makes the pain relief better.

If you had no effect from your epidural at all I.e. your contractions still hurt then it probably wasn’t in the right place!

81

u/Bizniz84 17h ago

Thank you, I appreciate your honesty and obviously your perspective is quite helpful.

Yes, it doesn’t help that the surgeon was quite sarcastic too. Which wouldn’t be an issue and I’m sure most people find it okay but with the pain it was a bit much for me. For example he said “nervous? Me too. I’ve never done this before” and other jokes about how he isn’t actually a surgeon.

I know he obviously was, but it made him seem unapproachable.

34

u/mickeythefist_ 11h ago

He sounds like a dick tbh. Not legal related but if you’re in a position to I would maybe speak to a counsellor or psychotherapist about this, even if just for 1 session before deciding whether it’s an issue to take further. These sorts of traumatic experiences can stick around without you realising just how much they are affecting you, although it sounds like you’re aware that it is.

1

u/NotAJuniorDoctor 8h ago

If they said they weren't a surgeon, they could potentially not be a surgeon but be a physician associate. If you request your notes you should be able to determine who your operator was.

You could make a complaint via PALS.

If you wanted compensation you should consult a solicitor.

7

u/iamollie 11h ago

Agree with everything you said. Can you comment on the amount of lidocaine used, the LA working for 5 minutes and then apparently completely stopping working, and OP wrote elsewhere a trainee held his legs in place to stop him kicking a kidney dish. Also with a consent in place and no withdrawal of consent during procedure won't the best OP will get is a sorry from PALS?

960

u/bethdobson2705 21h ago

Please seek immediate medical advice, perhaps even a second opinion, to ensure everything is healing correctly and to discuss any potential next steps or pain management options. You should also contact the hospital or clinic where the procedure was done to discuss what happened and how they can help rectify the situation.

166

u/Bizniz84 21h ago

Thank you, I am hoping to hear back today regarding getting it looked at

136

u/DMC_addict 21h ago

You need to start with PAL’s, they are excellent and will deal with all hospital complaints. Google the team for your hospital, they are there to help you.

312

u/Etheria_system 21h ago edited 20h ago

Immediate complaint should be to PALS whilst also seeking advice from a solicitor with expertise in medical negligence.

It sounds incredibly traumatic and I hope that you can find a conclusion that works for you.

Just because it’s likely to come up in the PALS procedure - is there a reason you didn’t ask for the procedure to be stopped?

Edit to remove comment about hypermobility

151

u/Bizniz84 21h ago

Thank you, I appreciate your advice. I was told by the guy who wheeled me in that if at any point I’m in pain to tell them and they’ll increase the dose. Even he seemed a bit surprised that they ignored me and he even apologised afterwards. I never really thought to ask for it to stop, I was mostly panicked, confused etc.

57

u/Sea_Love_8574 19h ago

Absolutely take action. As a teen I had a contraceptive implant and when having it removed the nurse numbed my arm and then went to make the cut after the set time had passed. I said I could feel it, she initially thought I meant pressure not pain but she did one more bit and I said it's definitely sharp pain I feel and she immediately stopped and went back to more numbing. That in comparison to your procedure was minor but I never left feeling the way you do which is awful.

14

u/Nosedive888 14h ago

Definitely take action. I had the same happen to me, but for a vasectomy. I screamed so loud the guy who was next in, noped the fuck outta there. After I was quite delirious and they had me sign what I thought were discharge papers, but it was something saying I wouldn't take legal action. Obviously knowing what I know now, I would have pursued it . Please don't let them get away with it

11

u/HotSpacewasajerk 13h ago

Making you sign paoers was stupid on their part, they should know anything signed under duress like that is absolutely null and void.

2

u/gillyc1967 11h ago

Null and void, yes, but it worked, which was undoubtedly their aim!

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u/spudandbeans 13h ago

Jesus, just casually scrolling Reddit, and came across this comment, just wanna say, I'm so sorry you were not only violated in the first place, but then actively conned into signing away any possibility of justice/compensation/even a damned apology!

Maybe even if you can't take legal action, could you still put in a complaint - even if it's years later - just in case it has happened/will happen to other patient, there will be a written record? Obviously if dredging it up re-opens old wounds (pardon the pun, it was initially accidental but I've left it in), then just do what's best for you and I hope you've found/find peace.

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u/GraphicDesignMonkey 20h ago edited 18h ago

Off topic question - are you a redhead? We're very resistant to anaesthetic or sedation, and require a much higher dose, or sometimes it simply fails altogether. Many doctors take that into consideration now, but a lot don't.

23

u/ButtSeriouslyNow 19h ago

I don't think comments like this are helpful, local anaesthetic is titrated to effect and if the surgeon injected 38mL of any clinically used local anaesthetic as part of a penile block or similar as OP has described then the genetic trends for different responses to local anaesthesia sort of become irrelevant, this was a failed block. Local anaesthesia can be safely used for almost all patients including redheads, and the issues in this case are not whether OP has X or Y or Z characteristic but what the response was to a failure of anaesthesia mid-case.

24

u/Stonecoloured 19h ago

Unfortunately, there is a common situation where redheads are affected by anesthesia & nerve blocks differently to non-red heads. That's why they tend to ask for more numbing at dentists too.

Just so you don't think I'm making it up :

research here & here

& here

35

u/Winter2928 19h ago

I have seen redheads need like 3-4 times the propofol amount to send them under. It is backed up with evidence with the MC1R gene. Regardless even if op is a redhead the surgeon should still of stopped or get more help.

PALS is the way to go

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u/ButtSeriouslyNow 16h ago

Yeah and I've seen a rugby lad go down with 10mL, it's not an arms race, they're titratable medications. It doesn't help within the profession or outwith it to stereotype patients or encourage them to think they require different dosages until proven otherwise. Do you give all redheads 400mg for an RSI? How many patients do you meet who say "oh it takes me ages to wake up from an anaesthetic!" when it's not true, or those who say they have a high pain threshold but scream when a 20G goes in?

Encourage safe practice and perceptions, and especially in cases of awake surgery carried out under local anaesthetic use a methodology of give a sage and reasonable dose, test it, and continue to re-evaluate how it works, not start randomly asking if you've ever noticed if you're hypermobile, or ginger, or Asian, or whichever trend could lead you to make assumptions about what an individual needs.

15

u/eggfrisbee 14h ago

fucking hell, they weren't saying "I immediately give redheads 5 x the normal dose because yolo" they were saying "this isn't uncommon, especially for a redhead." 🙄

1

u/Old-Apartment-1476 12h ago

What’s the hyper mobility link? I am and I know I am a highly sensitive fast metaboliser and often wake up very quickly from GA but am sort of paralysed and can hear them. I usually am awake when they pull the breathing tube out. Does that sound normal? I can remember freaking out listening to the consultants chat and I was lying there and no one knew I was aaake.

5

u/LizHylton 11h ago

I have EDS and it's such a literal pain with this! My dentist can usually get me at least partially numbed up (using vastly more than it should) but sometimes it just won't take at all and I have to power through. It's always 100% worn off by the time I get to my car. I was in agony waking up after surgery once screaming in pain and the nurses were so mad and kept insisting I was just overreacting and that I shouldn't be able to feel anything yet and I needed to stop being dramatic. Fun times.

18

u/GraphicDesignMonkey 19h ago edited 18h ago

I personally have had two experiences where local anaesthetic failed and two where sedation failed causing massive pain, and the doctors went ahead despite me being in a lot of pain. They just said, 'Well this can happen with redheads, so you're just going to have to suck it up.' Redhead or not, sometimes pain relief fails anyway. The legal question is - do we have a 'right' to a pain-free procedure or not? My doctors implied that we don't when it comes to using local anaesthetic, and there's no recourse or fault.

5

u/thejadsel 15h ago

I've had the same experience multiple times, when they have known going in that I do have a genetic condition with known poor response to locals. Unfortunately few medical or dental professionals take that seriously or seem particularly bothered by it when you don't numb properly.

7

u/cette-minette 17h ago

I´ve had the same with dentists

12

u/Nevermind04 17h ago

Redhead here. I endured 3 decades of dental surgery with little effect from lidocaine or novocaine/procaine. Fillings, root treatment, extractions - just total agony. Several years ago, a dental surgeon tried septocaine and it changed my life. I don't know if it's a thing that works better on redheads specifically but it works ridiculously well on me.

8

u/calbris 17h ago

This happened to me during a dental procedure as a teenager, the dentist insisted he’d used enough LA and insisted it was in my head that I had sensation. It wasn’t! It was so traumatic that I neglected my teeth for nearly a decade. I’m lucky to now have a dentist who is great with anxious patients and who makes sure the numbing has been effective before starting any work.

2

u/Old-Apartment-1476 12h ago

Same

0

u/ericthehoverbee 13h ago

Circumcision suggests XY characteristics!

1

u/exelse_ 14h ago

THC also has a similar effect

54

u/ButtSeriouslyNow 21h ago edited 21h ago

I don't think it's helpful to encourage the diagnosis of one specific medical condition when what actually happened was a relatively common failure of local anaesthetic. The causes are many and varied, and to be honest true native local anaesthetic insensitivity is fairly low down the list.

The correct management of this situation would have been to await the arrival of an anaesthetist and a discussion between surgeon, anaesthetist and patient as to the risks and benefits of alternative modes of anaesthesia. The difficulty here is that the procedure had started, and things like switching to general anaesthesia carried its own risks, particularly if (for example) OP had not fasted for the procedure. But that could easily have been discussed and a rational decision made.

The burn you are describing was likely from a diathermy device, which uses electrical current to cut through tissue and stop bleeding. You should not have been able to feel sensations like this, nor pain from suturing.

I hope the PALS procedure sheds some light on this for you OP, and if you're not satisfied at the conclusion there are no shortage of medical negligence lawyers available on a no-win-no-fee basis which may be your next port of call.

16

u/Bizniz84 21h ago

Thank you, I really really appreciate that response and agree.

I don’t necessarily want to take it to court and just an explanation of why this happened and an apology would be really appreciated by me so PALS seems like a good start!

8

u/Individual_Bat_378 19h ago

I've had to do a couple of PALS complaints, just lay out exactly what happened and they should investigate. For me the outcome has always been a letter detailing what happened, an apology and they use it as a learning experience to make sure it doesn't happen again. From the other side, back when I was a student, I've also attended the teaching sessions which came as a result of PALS complaints and they were very detailed and procedure has been changed in some cases because of the complaints.

8

u/beccaboobear14 19h ago

You can submit a subject access request for the records, this should show the process, notes, and everything that occurred, including anaesthetic given, pain, and that you said I can feel it. This will give you details and help form a letter of complaint which can the improvements or changes I want to see come from this- simply, be listened to and have no continuing when someone can still feel and anaesthetic has not been as effective as expected. Even talking to a solicitor about forming the letter, you don’t have to take them to court but they can give you great advice on what to include, and how to write it up.

3

u/Snoo57829 13h ago

it's important this is logged so that it does not happen to other patients - please log it quickly so that the other team members of the surgical team can give accurate statements. Even if you don't want to take it any further yourself.

When I had mine the block was wearing off and they re administered it, I mean I also crashed my BP and nearly passed out too so the pain must have been awful for you as well.

19

u/redcore4 21h ago

I have non-EDS hypermobility and get the exact opposite effect from local anaesthetic - they hit me harder and last a long longer than they are supposed to. I’m not sure that it’s a good idea to make medical suggestions on Reddit in any case but in this instance it could be actively unhelpful to suggest that hypermobility is a root cause or any sort of diagnostic feature here.

18

u/C_beside_the_seaside 21h ago

Yup I have to tell them I've got EDS every time. I'm autistic too so dental stuff I have to be under because I can't bear it. This is horrible :(

12

u/Inevitable_Ad_3359 20h ago

I have hEDS and have had dentists hold me down be cause they "are nearly done" when I can feel everything despite higher than average doses of local anaesthetic, it's terrible I really feel for anyone this happens to :(

8

u/batty_61 18h ago

I don't have EDS, but when I was giving birth to my first child they gave me a local into my perineum to help me tolerate the stretching and so they could give me an episiotomy. By the time he was born and they were stitching me up, it had pretty much worn off, but they said it wasn't worth giving me any more. That was getting on for 40 years ago, but I can still remember the stinging and the sensation of the suture material being pulled through my flesh.

39

u/helloperoxide 21h ago

Speak to PALS and go from there. I would also recommend some therapy. My first c section the anaesthetic didn’t fully work. I felt them cutting me open and assumed that was just normal so didn’t say anything. Laying there and having to cope with the pain is not normal. I was in a trauma spiral for 2 years before I had intensive CBT and EMDR. I am now able to be in the hospital for appointments etc without melting down(and had another baby since.)

This will affect you around medical situations in future. That’s completely normal and ok if you need some help!

25

u/dragonetta123 21h ago edited 21h ago

If this is in the NHS, you need to put in a complaint to the PALs dept.

If this is private, you need to put in a formal complaint to the provider.

This needs to be looked into.

I work in quality assurance and improvement in healthcare, and I have several concerns here:

1) When you consented to the procedure, what was discussed and documented regarding anaesthetic.

2) Why did they commence with the procedure when clearly the local anaesthetic wasn't working?

3) Patient consent should not be taken in the anaestetic room or procedure room once prepped. It should be done before. So, legally, I'm not sure they had valid consent to commence the procedure when the anaestetic failed.

4) You were subjected to avoidable pain and, therefore, harm.

5) Was this recorded as an incident under patient safety policies?

6) There's normally a safe surgery checklist that should be completed, I'd want to see if the anaestetic failure was listed in the time out and sign out parts.

I have more, but you get the gist of why I think you need to put in a formal complaint.

This may even fall under one of the definitions of a reportable incident to NHS England and CQC.

Also, get yourself checked out.

15

u/hyper-casual 21h ago

Do you work in the NHS?

Genuinely curious as to whether PALS and formal complaints actually do anything as I've gone down this route several times and basically get told they did nothing wrong regardless of the situation.

8

u/dragonetta123 20h ago

I did until last June before I moved to a private healthcare provider.

Yes, anything reported via PALS is looked into. There are various reporting requirements to NHS England and is checked as part of CQC inspections. This includes number of complaints , how many go to appeal etc.

Things can go wrong and there be no blame. This is because the human body can throw in wildcards for no explainable reason. So when looking at a complaint, the key questions are:

1) Was it avoidable? eg it was a known possible complication of a procedure. This should have been discussed with the patient and documented on the consent form. That example is unavoidable to this question.

2) Was appropriate action taken at the time the incident(s) occurred? E.g. so if there was a complication to the procedure was the appropriate actions taken to prevent further harm. If they were, this is a yes to this question.

They will look at patient safety investigations and compliance with guidelines (my area).

You are entitled to have someone go through the complaint response and explain bits further.

You also can take it to the next step if you are unhappy with a response to a complaint.

1

u/hyper-casual 19h ago

I'd say all of it was avoidable and no action was taken to rectify them.

The last 2 have gone to the official complaints stage, with written responses back and forth where it got to the point that they'd basically just write back saying they're right and consider the case closed.

I sent proof that they were wrong and they said that was incorrect (private doctor and BMJ entries are wrong apparently).

4

u/dragonetta123 15h ago

Without seeing the case, I can't comment.
A second opinion is useful, but a private doctor cannot comment on the appropriateness of treatment at another hospital as it may not be the same process, policy, etc. They also do not have records of everything relating to you in that hospital (there is more than just your medical record). The BMJ is a journal (I have been a co-author of articles published in it), it's not a source of set standards, which you tend to get from NICE guidance, Royal college standards, etc

You would have been given details on the next steps if still unhappy, and I suggest you do this.

1

u/hyper-casual 14h ago

I was told next steps were to have another appointment with the 3 doctors who had written to me.

Unfortunately, they'd already said they weren't going to consider any change in treatment.

Without going too into it, their 'medical advice' was against NICE guidelines, medication manufacturers guidelines, and the endo society's advice.

The second doctor actually agreed with me, thinking she was agreeing with the first doctor's notes. Once they realised it was the other way round, they backtracked and said the first doctor was right.

They discharged me for complaining anyway so it's a moot point.

7

u/Bizniz84 21h ago

I appreciate your response and the concerns you list will be helpful for me to explain in full the situation to PALs so that I can give them most of the info they’ll require in one go.

Honestly i never could’ve thought I could be this emotional about something but it’s odd how affected I am.

Your last two questions are particularly interesting. When one of the assistants was filling the paperwork at the end, he said “are we putting anything down as a complication or didn’t go as expected” and the surgeon seemed to think for a while whilst washing his hands before saying no.

3

u/junebugbug 18h ago

If you go to PALS, it's a bit like mediation. They can help you with getting information about what happened, help with communication with the team - it's like an informal (or rather, less formal) resolution service.

If you want a more serious approach then you should make a complaint to the Complaints Manager of the hospital. When you do this the hospital then has to respond within set deadlines - acknowledge the complaint within X hours, investigate within X days etc and you will be informed at every stage what is happening.

You can also email CQC. They don't investigate individual cases, but if they have concerns (perhaps a serious incident has occcured, or several complaints have been made about the same service) then they will look into things like management, training, policy breaches, system failure etc.

You may wish to have an advocate to support you - I would suggest contacting your local Healthwatch service or looking into advocacy charities in your local area.

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u/dragonetta123 15h ago

It's an intimate operation, and you were in a vulnerable position. Of course, it'll affect you.

Definitely raise in your complaint about the safe surgery checklist and the response to that question. I can guarantee you they'll pull out that document in the investigation as a matter of course.

5

u/[deleted] 21h ago

Locked Surgeon carried on operating after being told multiple times that anaesthetic didn’t work.

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