I recently went to the dentist to get a tooth filled and was given 2 vials of carbocaine. I was given carbocaine because my body cannot handle epinephrine. I have a rapid heart beat and it tends to aggravate it. An hour after being injected with the Carbocaine my whole lip and cheek swelled up like a balloon. My dentist and my doctor are perplexed as the cause of this reaction. Have you heard of anyone else having this type of reaction to Carbocaine? 

Carbocaine is mepivacaine, a local anesthetic of the "amide" group. Its relatives include lidocaine and bupivacaine. Epinephrine is added to local anesthetics to prolong their effect. Mepivacaine is sometimes used in patients who cannot tolerate epinephrine because it has a longer duration of action than lidocaine. 

It sounds like you may have had an allergic reaction. The reaction could be due to the mepivacaine, to some additive in the mepivacaine, or to something else entirely. Mepivacaine does not usually contain additives, but you should check with your dentist on that. Allergy to mepivacaine itself is quite rare but does occur. You can be checked for allergy with skin tests administered by an allergist (a specialist in allergy). 

One final possibility is that you experienced a reaction the gloves used by your dentist (usually latex) or by something else she put in your mouth. The fact that the swelling was only on the side of the injection suggests that latex allergy was not the culprit. 

An alternative to mepivacaine is a drug of the same class called bupivacaine. Your dentist might consider bupivacaine for future dental procedures. Bupivacaineﾠis not known to cross-react with mepivacaine. There are also local anesthetics of an entirely different class, called esters, which could be used. 

I think it is worth following this up with an allergist because the type of reaction you describe could be associated with more serious life-threatening reactions, which luckily did not occur in this case. 

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 recently had arthroscopic surgery for torn rotator cuff. During the nerve block procedure some anesthetic got into a vein. Do I need to be concerned about any permanent damage or complications? 

Thanks for your question. You probably had a brachial plexus block. The brachial plexus is a grouping of nerves coming from the cervical (neck) portion of the spinal cord. These nerves can be blocked by injecting local anesthetic in the neck area, or above or below the clavicle (collar bone). The injection has to be very precise to achieve the desired effect, and also to avoid injecting the anesthetic medication into the wrong structures. 

One of the structures in the neck to avoid injecting into is the vertebral artery. There are also veins in this area. If anesthetic is unintentionally injected into a blood vessel, the consequences range from none to serious. Mild symptoms can occur (ringing in the ears, dizziness, numbness around the mouth, metallic taste) for a minute or two. If enough anesthetic gets into the blood stream however, especially if injected into the vertebral artery, seizures (convulsions) and unconsciousness can occur. If seizures occur, these can be fairly easily managed with normal resuscitation measures and they stop within minutes as the anesthetic is processed by your body. Finally, if enough anesthetic of a particular kind (such as the commonly used bupivacaine) gets in, heart disturbances, and even cardiac arrest can occur. This is very rare but of course very serious, and also much harder to treat successfully. 

To avoid such rare but awful consequences a great deal of care is taken. Various methods are available to make sure the needle is in the right place (e.g. nerve stimulators, ultrasound) Before any significant amount of anesthetic is injected, the doctor will be draw back on the syringe (aspirate) to make sure there is no blood. A small amount of anesthetic may be administered initially and then there is a pause to ensure there are no problems. Then the rest of the dose is administered slowly and carefully, making sure the position of the needle does not change. 

If you're writing and asking me about this, you survived the injection of anesthetic into a vein. In this type of case there are usually no known long term problems of the kinds you mention. 

I have to go in for a minor dental procedure which requires the use of a local anesthetic. I am also taking Zoloft and Ativan for anxiety and to block panic attacks. Do these drugs interfere or cause problems with any local anesthetic that the dentist might use? 

As you have noted, Zoloft is a commonly prescribed antidepressant medication that is also used to treat anxiety disorders. Ativan is a benzodiazepine, (in the same group as Valium) and is another drug that is effective for anxiety. Please be assured that neither of these drugs should interfere in any significant way with the actions of local anesthetics. 

If you are afraid that your dental procedure might trigger anxiety or even a panic attack it would be particularly important to take your medications on the day of the procedure. 

I would advise you to call your dentist to discuss your concerns. Many dentists are trained and licensed to administer sedative and anesthetic drugs, which might make the whole experience easier for you. 

What is the procedure for this type of block, what anesthetic is used, and is it painful? 

A digital nerve block of the toe can be done by injecting local anesthetic into the webspace on either side of the toe. This is a simple anesthetic technique suitable for minor surgical procedures. It does involve two skin punctures with a needle and a certain amount of burning discomfort as the local anesthetic is injected. This discomfort can be alleviated with intravenous sedative or analgesic drugs. However for the type of minor procedure that a digital block is most often used for, an IV may not be considered necessary. 

Almost any local anesthetic can be used (examples: lidocaine, bupivacaine, mepivacaine, procaine). The key safety factor is the absolute prohibition on the use of adrenaline (epinephrine), an otherwise common additive to local anesthetic mixtures. The adrenaline may cause ischemia (reduced blood supply) of the toe, and even gangrene. A nasty potential complication of an otherwise very safe anesthetic! 

Iﾠknow local anesthesia will be used to remove a wart from the side of my foot, but what is the drug used, how long does it take to set up, and how is it administered? 

I am going to assume that your wart is rather small and that your doctor is going to remove it in her office. If this is the case, then your doctor will have a choice of a few different local anesthetics. In the United States, the most commonly used short-acting local anesthetic is called lidocaine. Other local anesthetics include procaine, mepivacaine, ropivacaine, and bupivacaine. As you might have guessed, cocaine is also a local anesthetic but not used for this purpose. Your doctor will probably inject the local anesthetic under and around the wart, using a syringe which contains the anesthetic, and a needle. The injection will sting, but the discomfort does not last long, and the effect is almost instantaneous. 

Two years ago, I had some some GYN office surgery done with Lidocaine. First shot was fine, but the second one immediately gave me a feeling of a giant panic attack, racing heart, shivering, dizziness and tongue numbness and a metallic taste in the mouth. It lasted a half hour or more. Very scary! After that, my doctor said to avoid anything with Epinephrine. (I will also add, that I have diagnosed anxiety disorder and a mitral valve prolapse) I regularly take Prozac and Xanax. 

Two weeks ago, I told my dentist not to use epinephrine, so she chose Carbocaine. I was told it was epinephrine-free. Guess what? After six shots, (four hour appointment!) I got dizzy, nauseated, felt like fainting, rapid heart, and shaking! Luckily I had a Xanax with me and took it. It helped some. But I really felt shaky all day after that. 

Today, I needed the crowns put on my teeth. So I pre-medicated with a Xanax with the advise of my doctor. My dentist only gave me a very small amount...one shot. Within two minutes of the injection, I had a similar reaction, but not anywhere as bad as the "six shot event". I got dizzy and a really rapid heartbeat. I told her to stop and I would take the pain without any drugs. I am at a quandary as to what to do about this. God forbid I needed local surgery at some time, or what happens when I need to have a tooth filled? Is this an allergic reaction to the Carbocaine or other reaction? I have used Novacaine for years for regular dental work, so why am I reacting now? Should I get allergy tested? Should I see an anesthesiologist for a consultation on this issue? And might acupuncture work for pain control? I truly appreciate your advice and any recommendation you might give me. Thanks so much 

Thanks for sharing your story with me. The description you give of your reaction to the injection with lidocaine is very very typical of the effects that results from the absorption of local anesthetic agents of any type (including carbocaine) into the blood stream. In most cases, only small amounts of anesthetic over time are absorbed. If a blood vessel is close to the site of injection, or the needle actually enters a blood vessel, far more anesthetic is absorbed, quickly, and produces the unpleasant symptoms you've described. 

Very often, when patients have the reaction you've described, it is attributed to "allergy" to the local anesthetic, which it is not, or to the effects of the epinephrine that is often part of the local anesthetic formulation (it's not that either). The purpose of adding epinephrine in fact is to limit the absorption of local anesthetic into the blood, and to prolong the effect of the anesthetic itself. If the needle is inserted into a blood vessel, and the anesthetic contains epinephrine, the patient will often experience a sudden rapid increase in heart rate. This may be unpleasant, but is also used by anesthesiologists as a useful warning sign, indicating that the needle should be repositioned! 

After six shots of local anesthetic it is possible that you had been given close to the maximum amount of local anesthetic. Because eventually the anesthetic is, over time, absorbed, the more you are given within a space of time, the more possible it is to begin to experience side effects, even if the needle is accurately positioned. With your history of panic attacks it is also possible that many of the symptoms you have described could be due, pure and simple, to an overwhelming anxiety attack. Four hours in a dentistﾒs chair is enough to give anyone a fright! 

My suggestion to you is that you ask your dentist to arrange for you to receive a decent amount of intravenous sedation for any significant dental work in the future. The dentist may not be able to do this herself, but there are anesthesiologists who do this kind of work, and even companies devoting themselves entirely to this service. There is no reason, with modern anesthesia and dentistry, why you should not have a sa fe, tolerable or even pleasant experience at the dentist next time. 

Many years ago when I had a wisdom tooth taken out the dentist gave me several injections before the area would become numb, and then it only lasted for maybe 2-3 minutes. I never thought anything about it until I had my first child and the epidural did not work, I had a team of anesthesiologists in my room who after repeated attempts could not get it to work. I don`t know what was more painful the birth or feeling the epidural needle. 

After the birth of my second child where the epidural did not work again, I had to have surgey and upon waking up found out that I have an immunity to Morphine, Demerol and Codeine, as none of these drugs worked on me at all. That was a fun thing to have to find out after a major surgery! The only pain drug they gave me that worked was Toradol. 

After this surgery I found out that my grandfather and an Aunt have the same problems. Pain drugs and local anesthetics do not work on them either. My grandfather's docotor told him that he thinks his body produces an enzyme, almost like its an allergic reaction to the anesthetic and it attacks it immediately and breaks it down so that it does not localize. 

In the past year I`ve had a small area of skin cut off for biopsy and a finger stitched up where once again after several shots the area still did not get numb and I had to bear the pain as they had no other alternative to numb me for these minor procedures. I`ve spoken with my family doctor who seems to be stumped for an explanation of this. I`m trying to find out if there is a name for this condition or any information about it before I need another surgery or minor procedure done, as doctors tend not to believe me until after a half dozen injections I can still feel their needle or razor blade. Minor procedures I`ve tolerated pretty well but if something serious were to happen i`d like to be able to explain it better so I could justify them putting me to sleep for something they normally would do a local anesthetic for. Thanks. 

ﾠThanks for your very interesting question. It's very difficult to explain your problems with a single "defect" or condition. 

Local anesthetics work on cell receptors called sodium channels and it is possible that you have an altered form of sodium channel which makes you resistant to the effects of local anesthetics. There are two different groups of local anesthetics - amides and esters, and you should ask your doctors to make sure they try at least one from each group. 

There are also people who have different endorphine receptors - these are the receptors for morphine, and other narcotic (pain-killer) drugs. However morphine and Demerol have completely different structures and it's hard to explain why you would be resistant to both of them. There are other narcotics that may not have been tried in your case, such as fentanyl, alfentanil and sufentanil, so your doctors could perhaps try those. 

Finally, there are genetic variations in the way people break down and get rid of drugs like codeine, which can dramatically affect the dose need to get pain relief. 

So receptors might not be the problem at all, rather some abnormality of pain perception or of conduction (nerve) pathways. Do you have increased sensitivity to painful things, or things that would not ordinarily cause pain? Are you taking any other medications that might affect your perception of pain? Are there any other medications to which you have had an unusual response? These are questions your doctors might want to ask, and if you want to pursue it further you could go to the anesthesia department in your local academic medical center to find out whether anyone would like to help you get to the bottom of this interesting and unusual problem. 

I am going to be having surgery on my right talus in January due to avascular necrosis. It is vital that I be functionally cognitive and alert very soon following the surgery -- it`s the first day of classes, and I have to be able to function for a law class. I would prefer a popliteal block with local to cover whatever isn`t taken care of through the block. 

I`m wondering about sedation -- can the anesthesiologist give me some type of medication so that if I hear "uh-oh" I don`t freak out and try to run from the OR with my foot sliced open, while keeping me alert enough (not necessarily completely functional throughout the surgery) so that I can see parts of the operation? 

If I tell my anesthesiologist that I`d prefer a popliteal block, will he/she look at me like I`m an idiot? Or, would I be better off to explain that I need to be functional and cognitive very quickly after the surgery? Any advice you can offer would be great! 

I am scheduled to have surgery on my ankle due to a bone fragment located around the front of the ankle joint. The doctor mentioned that they generally use a block in the back of the knee as well as anesthetic. I was wondering about the procedure for the block, how it is administered and am I awake during this procedure. Also, what type of anesthetic is generally used with this type of block. Also, is a trach tube used as well? I would appreciate any help you can give me. 

Your doctor is probably referring to a popliteal nerve block. Branches of the sciatic nerve supply the leg below the knee. A needle isﾠinserted in exactly the right location, and local anesthetic is injected through it.ﾠ 

Such nerve blocks are usually administered with the patient lightly sedated - awake enough to cooperateﾠas needed, but calm and comfortable enough to tolerate the discomfort of the needle. 

The block is often done with the aid of a nerve stimulator or ultrasound imaging, to help find the nerves. The degree of discomfort is usually mild. The nerve stimulator works with small amounts of electrical current. As the needle approaches the nerve, it causes the muscles supplied by that nerve to contract. 

Once the block has been administered, the choices are (1) general anesthesia; (2) mild, moderate or deep sedation; (3) nothing (!). 

Obviously the block has to be very effective for no sedation to be given. Even if there is a very effective sensory block, most patients like to have some anxiety relief and/or mild sedation, so the appropriate agents are given intravenously. If this is the case you will also be given some extra oxygen to breathe through a face mask or a nasal cannula. 

Your anesthesiologist will discuss the options with you. Even if a general anesthetic is used, a tracheal tube might not be necessary, unless you have to be prone (face-down) during the procedure. 

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`m only 52, but I have BPH which has not responded to Avodart and Flomax...these worked for a year then I`m back to my usual up 5-6 times per night. I saw a urologist who said that I was a good candidate for PVP green light laser treatment......I would love to do it, but my concern is the anesthesia.......the video that I saw said "pudental" block or something like that plus painkillers; I just don`t want any "sedation" due to a previous bad experience with so called "conscious sedation".....is this reasonable? Any info will be geratly appreciated. Thanks 

It is possible to have prostate surgery with a local anesthetic block. Needles can be inserted via the lower abdomen (suprapubic area) and/or the perineum to reach the neurovascular bundle that supplies the prostate, or the pudendal nerve. I am not certain how effective this block is. It is not a block performed routinely by anesthesiologists. 

Prostate surgery is usually done with either spinal or general anesthesia, not the technique you mention. Perhaps your surgeon has a lot of experience with this technique. He would then be able to tell you how complete the anesthesia is, and how much discomfort you might expect. This in turn would affect how much, and what kind of sedation or pain-killing medication you would need in addition to the block. 

I recently had Novocain when I had 2 wisdom teeth pulled. Does Novocain have any impact on the effectiveness of birth control pills? 

Novocain is the brand name for the local anesthetic procaine. Procaine was the first injectable local anesthetic, developed in 1905. Procaine is no longer commonly used, having been replaced by other local anesthetics such as lidocaine. I searched two different drug formularies and could find nothing to suggest an interaction between either lidocaineﾠor procaine, and birth control pills. This seems particularly unlikely to occur after a single dose of local anesthetic for tooth extraction. 

I had 4 wisdom teeth out this morning with local anesthesia. It`s been almost 12 hours and my lower lip and chin is still numb. How soon should this wear off if it is just the normal effects of the anesthesia, and when should I start worrying that the nerve was damaged, causing this numbness? 

I certainly hope the numbness has worn off by the time you read this response! Please understand that this is not a source of emergency care and is not a substitute for care from your phyician or other provider. 

The duration of anesthesia depends on the type of local anesthetic used, as well as the presence of additives such as epinephrine which prolong the numbness. There can also be quite a bit of variability from person to person even when given the same amount and type of anesthetic. Twelve hours is probably at the outside limit of most dental anesthesia, so it may be advisable to contact your dentist if you are still numb after this time has elapsed. 

Iﾠhave requested to be awake during my foot surgery and my surgeon will honor my request. The anesthesiologist, however, says she personally is a `wus` and suggests I have `10 minutes` of propofol or alfentanyl while the ankle block is set up as it is very painful for the patient. Is this a good suggestion, and will I indeed be awake after `10 minutes` to not miss the experience? 

It is pretty standard to administer some combination of drugs (midazolam, propofol, alfentanil, fentanyl being the most popular in the US) to reduce or eliminate the pain associated with needle insertion for regional anesthesia. 

Both propofol and alfentanil are short-acting drugs. Alfentanil is an opioid, in the same class as morphine. It is a profound analgesic but like other opioids does have sedative properties also. Propofol is an intravenous anesthetic or sedative drug. That is, in lower doses it is sedative, and as the dose is increased consciousness is lost. 

It is certainly possible that propofol and alfentanil, alone or in combination, could give you a 10 minute period of analgesia and sedation after which you would be fairly wide awake, to "enjoy" your operation! Neither of these drugs provide a complete on-off experience; there is likely to be at least bit of residual sedation for a while after. Another drug with a very short duration of action is remifentanil, which has a half-life of only 3 or 4 minutes. This is also an opioid medication. 

An ankle block involves at least 4 separate injections of local anesthetic so it can be quite painful. There are 4 branches of the sciatic nerve that must be blocked, and sometimes an additional injection across the top of the foot. An additional factor to keep in mind is that some surgeons like to use a tourniquet during the operation to minimise bleeding. The tourniquet is placed around the thigh very tightly and can lead to a significant amount of discomfort. 

I am a 38 year old woman, and had a root canal at my dentist`s office two weeks ago. I was given an anesthetic containing epinephrine, and just after it was administered, I got extremely light-headed and my arms suddenly felt like lead weights. After a while, the feeling subsided for the most part, but now I am left with weakness in my arms and a feeling like I`m trembly, not unlike after an adrenaline rush. I am concerned that it has not gone away. . .could this be permanent? Could this be an indication of an underlying problem that was just exacerbated by the medicine? Thanks for your help. 

Thanks for your question. The injection administered by your dentist would have contained an anesthetic - probably lignocaine or procaine - and adrenaline. The purpose of the adrenaline additive is to reduce the absorption of the anesthetic into the bloodstream. Absorption into the bloodstream reduces the duration of action of the anesthetic, which might mean that you would need more injections to keep the anesthetic going. 

Some patients have symptoms similar to those you describe when the injection is administered. These symptoms may be due either to the anesthetic or the adrenaline. Light-headedness or dizziness, palpitations, metallic taste in the mouth or jitteriness are among those symptoms. Usually these symptoms are short-lived and don't require treatment. 

Sometimes patients are told, mistakenly, or assume, mistakenly, that they are allergic to the local anesthetic. While allergies to local anesthetics do occur, in most cases they do not present in this way. It is certainly unusual for these possible side-effects to linger for two weeks. Even if a substantial amount of these drugs in absorbed into the blood, the body metabolizes and excretes them within minutes to hours. 

So, although I am not at all sure what your persisting weakness and trembling is due to, I think its unlikely to be a direct result of the dental anesthetic. If your symptoms do not go away, please be sure to consult your physician. 

I am going in for achilles rupture surgery. We discussed anesthesia options. I asked if an epidural would be adequate. He mentioned they may be able to provide anesthesia from my knee down then said or a spinal. He didn`t elaborate much further on that knee down anesthesia. What is the name of that technique of anesthesia and do you think it would be adequate for my surgery. I just want the safest for the purpose. 

There are several anesthesia options for Achilles tendon surgery. An epidural can be used, but is sometimes not quite as effective as a spinal anesthetic, because the nerves supplying the ankle area (the sacral nerves) are a bit harder to reach with the epidural anesthetic solution. 

The sciatic and/or popliteal nerves can be blocked to provide a good anesthetic for ankle surgery. This is probably the technique that your surgeon was referring to. 

A general anesthetic is of course also an acceptable option for many. 

Finally, an intravenous regional block, or Bier block, involves the application and inflation of a blood pressure around the thigh, and the intravenous injection of local anesthetic. This is probably the least suitable anesthetic for any major ankle surgery. 

Which is the safest alternative? Well, anesthesiologists are obsessed with safety. If there was a clear, best, safest alternative we would all be doing it. But safety is related to many factors. One important factor is the health of the patient, including the medical conditions of that patient, allergies, medications, etc. Another factor is the skill of the anesthesiologist (and of course the surgeon). Any competent anesthesiologist should be able to provide you a safe general anesthetic unless you have some unusually severe medical conditions. Popliteal and sciatic nerve blocks require quite a bit of practice to guarantee a high level of success. There is an art to it which involves appreciating the anatomy and placing the needle in exactly the right spot to get nerve blockade (without injuring the nerve). Newer technology such as ultrasound guidance may help us all to improve in this area. The "systems" of care in the hospital and outside of it also contribute to safety - information and communication, equipment, the quality of nursing care, follow-up care, etc. 

The bottom line is that any of the techniques described above can provide you with safe, effective anesthesia for Achilles tendon repair. You are best off discussing the choice and coming to an agreement with your anesthesiologist and surgeon. 

I need to have carpal tunnel release done on both hands; I have heard that it can be done without sedation (which I am scared to death of) with just some sort of "block", while others have told me that some sort of sedation must be addded.....I had a terrible reaction to "conscious sedation" before and could never do it again...........the pain is getting unbearable at night and the EMG/NCV tests have caused my doctor to refer me for surgery; which I would love to have if it can be done without sedation. Any help will be really appreciated. 

Carpal tunnel surgery can be done without sedation. Your surgeon can inject local anesthetic into the area as he works ("local"). Alternatively, an intravenous regional block ("Bier block") is very effective. Neither of these techniques require sedation, although in the majority of circumstances some sedation would be given to make the experience more comfortable. If you are sure you don't want the sedation it is likely that your anesthesiologist and surgeon will accommodate your request. 

How long does it take to get rid of local anesthesia in our system? 

ﾠThe answer is, it depends! It depends on what type of local anesthetic is used, the dose administered, where it is injected, what additives are put in the mix, and the body's processes of drug distribution, metabolism and excretion. Those processes depend on blood flow and on the efficiency of your liver and kidneys. An injection of the local anesthetic lidocaine for dental anesthesia or a peripheral nerve block might last only 30-60 minutes. An interscalene block with bupivacaine plus epinephrine and some steroid can last as long as 24 hours. 

I recently had rotator cuff surgery and a local block was performed. Can this type of anesthesia cause me to have severe sweating? I have the constant smell like diesel fuel is on everything I have changed bedding daily and the smell will not go away. I took very little pain medication. How do I get this out of my system? Thank you! 

Your anesthesia was probably some form of brachial plexus block. Typically this block causes decreased sweating through its effects on the sympathetic nervous system. Your unusual symptoms don't sound like they have anything to do with anesthesia or pain medication. 

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.