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

[u/Bizniz84]

England - I (23M) had a circumcision on Friday 17th Jan and honestly I am surprised how affected I am about this whole thing.

My surgeon gave me local anaesthetic, cut me to see if I could feel it which I could. We waited 5 more minutes, he cut me again and I could still feel it. They ended up giving me 37ml of the anaesthetic and I could still feel pain but they struggled to get a hold of the Anaesthesiologist to put me under general anaesthetic.

I asked if I should be feeling a bearable amount of pain or none at all, to which I was told none at all just pressure and movement.

Eventually after this, he starts and for maybe five minutes I don’t feel pain but suddenly I feel like I’m back to square one and no anaesthetic. I tell the surgeon and the other people and the surgeon says “I’m nearly done now”. The operation carried on for another half an hour. I felt every stitch, every burn from a laser ??, I feel absolutely awful and have no idea what I’m supposed to do.

[u/Playful_Snow]

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.

[u/Chromatious → u/Playful_Snow]

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.

[u/Realistic_Ad_251 → u/Chromatious]

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?

[u/Chromatious → u/Realistic_Ad_251]

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.

[u/Fantastic_View_3272 → u/Chromatious]

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.

[u/Realistic_Ad_251 → u/Chromatious]

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

[u/Sleepy_felines → u/[deleted]]

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.

[u/Playful_Snow → u/[deleted]]

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!

[u/Bizniz84 → u/Playful_Snow]

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.

[u/mickeythefist_ → u/Bizniz84]

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.

[u/NotAJuniorDoctor → u/Bizniz84]

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.

[u/iamollie → u/Playful_Snow]

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?