Hypnotic Sedation for Knee Reconstruction Surgery

    On the whole, a very good experience, easier than I expected and feared – I’m home the day after the operation @ Duke Hospital.  Though the anesthesiologist was understandably unfamiliar and not fully comfortable with patients using hypnosis for sedation, my surgeon, Samuel Wellman, MD was accepting of what I wanted to do, though he thought the electric saw and other sounds might be distressing.  I wasn’t fully convinced myself that hypnotic sedation was a good idea for this long operation until I realised in preparatory trances that, of course, I wasn’t comfortable beforehand discussing the operation with him because my conscious ideas and imaginings  were distorted by greatlyly exaggerated Scare.  And that’s why I wanted to use trance, because while in trance I was comfortable and confidant about my several previous experiences using trance for sedation and to minimize strong anxiety about medical procedures – arthoscopic  elbow tendon repair, several colonoscopies, and two recent cataract repairs.
   In trances for the 2 weeks before the operation I suggested very deep relaxation,  focus on absorption in my inner experience, and immobility during the procedure, as well as reducing my moderate anxiety, and expecting relatively rapid healing &  physical comfort.  I was pleased my sciatica didn’t prevent having a nerve block, not general anesthesia, so my mind was clear immediately afterward, and my mood was relieved & high – hungry, jabbery & somewhat entertaining, I’m told.  Hypnotic sedation worked so well I kept wondering whether and when my operation had begun or would begin, and was unaware that they manipulated my leg a lot.  Power saw & chisel sounds I was prepared for by watching in trance a YouTube video of a total knee reconstruction, so they were no bother.  We started about 90 minutes later than expected, & I’d prepareded just for a 1 & 1/2 hour procedure, so I was a bit restless internally the last 20 minutes, but not noticeably to the medical team.  Not un-expectedly, my noise suppressing headphones & Smart Phone-loaded cello music sterile and couldn’t go into the operating room.
I was sent home yesterday afternoon w/ a 2 day nerve block – this type’s fairly new for knees, & reduces pain for a while.  The PT  exercises are pretty uncomfortable as expected, damn near intolerable, and my first out-patient PT appointment is next Wednesday —  farther away than I’d hoped & 10 days sooner than the first available appointment thru their central scheduling, which couldn’t respond to my intended rapid rehab through PT, so I called Duke Sports Med directly,  and they understood the need.  I think most folks use narcotics those first weeks at home, so a quick start of PT  may not matter for them.
I have a basic Walker/ 2 wheels , no seat, ​ and will get a cane for transition to walking w/o aids in a few weeks –  2 or 3?.​   A machine circulating ice water around my knee helps reduce inflammation​ and swelling – they really offer the latest in support for recovery.  The staff was unusually well chosen, competent & supportive.  I can drive when off walking aids, & off narcotics, which I’ll will start if necessary, when the nerve block runs out.
Not yet know-able when I can drive to work.  I’ll just enjoy my stay-cation & do the damn PT exercises – they leave me kinda’ wrung-out.  Dr Bob

 

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3 Responses to Hypnotic Sedation for Knee Reconstruction Surgery

  1. Howard Leibowitz, M.D. says:

    You state that you had a “nerve block”. What type?

    • Dr. Bob says:

      Glad to hear from you HL, Somehow my earlier reply was lost. I actually had 2 nerve blocks: one during the operation to prevent pain, and the other went home with me and reduced pain for two days enough for me to manage with self-hypnosis without the prescribed narcotics – it was challenging but possible. Please ask again if more specific medical descriptions of the nerve blocks would be useful to you – I can check my Duke records. bd

    • Dr. Bob says:

      Dr HL, here’re the medical details on my nerve blocks – if I get it right now, there were 2 separate pre-op blocks, and 1 post op.

      Block: Spinal
      6/4/2014 12:21 PM

      Patient location: pre-op

      Preanesthetic checklist: patient identified, IV checked, site
      marked, risks and benefits discussed, surgical consent, monitors
      and equipment checked, pre-op evaluation, timeout performed and
      anesthesia consent

      Position: sitting
      Prep: ChloraPrep
      Approach: midline
      Spinal location: L3-4
      Injection technique: single shot
      Procedure performed without using ultrasound guided technique.

      Needle type: Quincke
      Needle gauge: 22 G
      Needle length: 100 mm
      Block drug: bupivacaine
      Block drug concentration: 0.5%
      Drug density: ISObaric

      Patient tolerance: patient tolerated the procedure well with no
      immediate complications

      Staffing
      Anesthesiologist: ROY, LANCE ATLAS
      CRNA/Resident: SATERI, SARA
      Performed by: attending and resident under supervision
      __________________________________________________________________
      __________
      Block: Peripheral
      6/4/2014 12:33 PM

      Patient location: pre-op

      Reason for block: (OR Block) performed for postoperative pain
      management as part of care plan discussed with SURGICAL team and
      patient

      Preanesthetic checklist: patient identified, IV checked, site
      marked, risks and benefits discussed, surgical consent, monitors
      and equipment checked, pre-op evaluation, timeout performed and
      anesthesia consent

      Anesthesia block type: posterior capsule.
      Position: supine
      Prep: ChloraPrep
      Approach: classical
      Laterality: right
      Technique adjunct: ultrasound guided
      Procedure performed using ultrasound guided technique.
      Needle type: Stimuplex
      Needle gauge: 21 G
      Needle length: 100 mm
      Block drug: ropivacaine
      Block drug concentration: 0.25%
      – with: epi 1:400K
      Agent volume = 20mL

      Injection response: no paresthesia on injection
      Ultrasound guidance: appropriate spread of the medication was
      noted in real time, no ultrasound evidence of intravascular
      and/or intraneural injection and needle tip was noted to be
      adjacent to the nerve/plexus identified.

      Patient tolerance: patient tolerated the procedure well with no
      immediate complications
      Additional procedure comments: The teaching provider was present
      during the key and critical portions of this procedure and
      immediately available throughout the entire procedure.

      Staffing
      Anesthesiologist: ROY, LANCE ATLAS
      CRNA/Resident: SATERI, SARA
      Performed by: resident under supervision and attending

      __________________________________________________________________
      _______
      Block: Peripheral
      6/4/2014 3:41 PM

      Patient location: PACU

      Reason for block: (OR Block) performed for postoperative pain
      management as part of care plan discussed with SURGICAL team and
      patient

      Preanesthetic checklist: patient identified, IV checked, site
      marked, risks and benefits discussed, surgical consent, monitors
      and equipment checked, pre-op evaluation, timeout performed and
      anesthesia consent

      Block type: adductor canal
      Position: supine
      Prep: ChloraPrep
      Laterality: right
      Technique adjunct: ultrasound guided
      Procedure performed using ultrasound guided technique.
      Needle type: Stimuplex
      Needle gauge: 18 G
      Needle length: 100 mm
      Block drug: ropivacaine
      Block drug concentration: 0.2%
      – with: epi 1:400K
      Agent volume = 20mL

      Injection response: no paresthesia on injection
      Ultrasound guidance: appropriate spread of the medication was
      noted in real time, no ultrasound evidence of intravascular
      and/or intraneural injection and needle tip was noted to be
      adjacent to the nerve/plexus identified.

      Catheter type: multi-orifice
      Catheter size: 20 G
      Catheter secured: 11 cm
      Block sterile dressing applied.
      No catheter blood aspirated

      Patient tolerance: patient tolerated the procedure well with no
      immediate complications
      Additional procedure comments: The teaching provider was present
      during the key and critical portions of this procedure and
      immediately available throughout the entire procedure.

      Staffing
      Anesthesiologist: ROY, LANCE ATLAS
      CRNA/Resident: BULLOCK, WILLIAM M
      Performed by: attending and resident under supervision

      __________________________________________________________________
      _______

      Component Results
      There is no component information for this result.

      General Information
      Resulted:
      06/04/2014 3:42 PM
      Ordered By:
      Sara Sateri, MD
      Result Status:
      Edited
      This test result has been released by an automatic process.
      Back to the Test Results List

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