Would it be proper to request an ankle block without sedation, perhaps a 5 mg. ativan to take the edge off any anxiety? I don`t want the amnesiac versed for my surgery since it does not provide any pain relief. 

You are correct that Versed (midazolam) does not provide any pain relief. So, is your request to not be given midazolam a proper one? It could be a mistake to tell the doctor, who is an expert in applied pharmacology, to avoid a particular drug without good reason. I believe the best approach is to discuss your concerns and your preferences with the anesthesiologist before the procedure. 

It sounds as though you would like to remain awake during the procedure - that is certainly a reasonable request for almost any orthopedic surgical procedure. Hammertoe surgery can be done with an ankle block, and a willing surgeon can supplement the block with infiltration of the field or digital nerve blocks if needed. If a tourniquet is required, placed on the leg or thigh, the ankle block will not cover that and a different plan will be necessary. 

I am wondering whether you might have read something on the internet or seen something on TV about the problem of awareness during general anesthesia, with or without the use of midazolam. This is a serious issue and a legitimate concern. However most anesthesiologists will tell you that the use of midazolam as part of the anesthetic, or as the premedication, does not create a problem in this respect. 

You should be aware also that Ativan (lorazepam) is a drug in the same class as midazolam (a benzodiazepine) and has the same effects. 

Benzodiazepines are sedative drugs that have other useful properties - they relieve anxiety, cause amnesia, relax muscles, and stop convulsions. So asking not to be given midazolam, while requesting lorazepam doesn't really make sense! 

If you have an ankle block, or other local or regional anesthetic, your anesthesiologist will generally try to respect your wish to be awake. If however you happen to become especially anxious or restless during the operation, midazolam is one of the main drugs used, in the United States anyway, to relieve that anxiety. If you are not doing well because the block is not completely effective and you are having pain, you would probably be given a drug like fentanyl (a pain-reliever), or given deep sedation (with a drug like propofol) or even general anesthesia (with a variety of different drugs). 

At the end of the day, it's your right to determine how you are treated, and by whom. As I've said before in this forum, it is also the right of the anesthesiologist not to administer treatment he or she believes to be unsafe or ineffective. Having said that, an anesthetic without midazolam certainly is not unsafe or ineffective. 

I asked a question priously about this topic. I had a procedure done using lidocaine and had severe palpatations and arrthmias after the injection in my forehead. So doc said it was due to epinephrine. We did a second procedure and used carbocaine plain (without epinephrine) I had the same reaction it started right after the injection was done and lasted about 10-15 minutes. I have read carbocaine without epinephrine can also cause these symptoms everybody thinks I am crazy but this is really happpening to me. I need a third procedure in 5 more days. What should I do this time. 

Thanks for your interesting question.ﾠ As always, the best way to sort this out is for your doctor to carefully evaluate what happened (both times) by taking a careful history, doing a thorough physical exam, and examining the records, to figure out whether you have any predisposing factors or underlying health problems. Questions that might usefully be asked include the following: Do you have any other known allergies? Are there any other medicines you are known to have had a reaction to? Is there any possibility that you are allergic to latex rubber (the material of which the doctor's gloves are made)? Where there any other symptoms that might suggest you were having an allergic reaction, such as dizziness and low blood pressure, wheezing and difficulty breathing, skin rash or hives, etc? Have you had similar experiences unrelated to medical procedures? Do you have any history of heart disease? Have you had an EKG (electrocardiogram)? (You probably should have one) If your problem is indeed related to the local anesthetic, it is possible that the reaction was due to rapid or excessive absorption of the local anesthetic into the bloodstream.ﾠ Any local anesthetic, including lidocaine and carbocaine, if absorbed into the bloodstream in sufficient amounts, can cause symptoms that include dizziness and lightheadedness, numbness around the mouth, tinnitus (a ringing noise in the ears), or a metallic taste.ﾠ Your doctor takes precautions to prevent this absorption, by aspirating (drawing back) on the syringe before injecting to make sure the needle is not in a blood vessel.ﾠ Nevertheless, absorption does take place over time. Both lidocaine and Carbocaine, also called mepivacaine, are amide local anesthetics.ﾠ The other major group of local anesthetics are the esters. ﾠIf you need another procedure, and local anesthetic must be used, it might be worth trying a medication from the ester group, such as procaine or chloroprocaine.ﾠ Overall, allergic reactions are more commonly associated with the esters than the amides, however. Methylparaben is an ingredient of local anesthetic preparations that is thought to contribute to untoward reactions to these useful drugs.ﾠ Methylparaben-free formulations are available for most local anesthetics, and your doctor might consider using one of those. It is hard to know how much of a risk is posed to you by these reactions you have had.ﾠ Your doctor needs to decide whether any future procedures ought to be done in a monitored setting, where your heart rate, blood pressure and other vital signs can be carefully and continuously watched. It might even be worth considering whether your forthcoming surgery - you don't say what it is - should be done under general anesthesia, thereby avoiding the need for local anesthetic altogether. 

I had elbow surgery yesterday and had nerve block how long does it take for it to wear off? 

It depends! It depends on the kind of nerve block, and the kind of local anesthetic that was used. Long acting local anesthetics, such as bupivacaine and ropivacaine, might last up to 12 hours or so. There are certain additives, such as clonidine, epinephrine (adrenaline), and corticosteroids that help to prolong the effect. The effects on movement ("motor effects") wear off more quickly than the the effects on feeling ("sensory effects"). If you had a single injection of local anesthetic and the effects have not worn off by the following day you should give your surgeon or anesthesiologist a call. 

I am scheduled next week to have a nerve block. Could you please explain to me how this procedure is done? 

ﾠ"Nerve block" is a term that refers to the use of local anesthetic medications ("novocaine"-like drugs) to block the transmission of pain in nerves. 

You can think of nerve blocks as being in one of two categories. The simplest type of block is where a single nerve is blocked. This is called a "peripheral nerve block", and is done by injecting local anesthetic close to the nerve. For example, dentists typically use a nerve block to anesthetize the teeth for dental surgery. 

In other cases, a group of nerves ("plexus") or even part of the spinal cord is blocked ("spinal" or "epidural" anesthesia"). Larger areas of the body can be anesthetized in this way. 

"Regional" anesthesia is another term to describe techniques using local anesthetic drugs. Regional anesthesia includes peripheral nerve blockade, spinal anesthesia, and other special techniques that block the pain of a surgical procedure without the patient having to be unconscious (general anesthesia). Skilled anesthesiologists can use regional anesthesia to allow many different types of surgery to be performed. 

Finally, nerve blocks are also used to treat various kinds of pain problems. For example, epidural injections of local anesthetic and steroid medication are used to treat back pain. Unfortunately, without more information about the surgery you are to undergo (or the pain problem that you might have) I cannot provide any details about the nerve block that might be used.