Not sure if this is the right forum but here goes. I have not seen anywhere, so far, on this site, anyone really describing their own personal experience for a procedure to any detail. I thought my recent experience might be of interest to some.
I have had this ganglion cyst that sits atop my right radial artery/nerve for several years. It had been gradually growing and was causing increasing pain and loss of fine motor control and strength. I just didn't want it to get out of control and need surgery emergently. So, I scheduled the surgery so as not to interfere with the work schedule. Went off coumadin 4 days in advance. I'm status post saddle PE. Surgeon told me that I didn't need a normal INR but below 2.0 would be good. I'm to get a Bier Block with sedation. The RN who is going to be starting both my IV's also is going to do a phlebotomy in addition to starting both an 18 Jelco and a 20 Jelco. I suggest that she just draw it from the 18 that she will be starting for my IV. She allows that they don't do that because they get some bad lab values on occasion. I tell her that is BS and she succumbs and does the INR from my IV start. INR comes back 2.29...and after she had already started my Bier Block IV at my suggestion assuring her that my INR would be fine. She now suggests that we repeat the INR, this time doing it her way from a venipuncture that does not include inserting a piece of Teflon. Result is now 1.89 and good enough for surgery...whew...couldn't imagine what I was going to be doing for the next 2 weeks that I had scheduled off for the surgery. Rescheduling the next day would not have been an option. 2 different machines were used for the INR...one in the preop holding area and the second one was done in the lab. Enough reason for the difference? And, which one was REALLY correct?
Morning of surgery I took a Celebrex 200mg. Discussed with MDA what I wanted for sedation. I always am interested in trying something new for my anesthesia experiences. For instance. Had a SAB for my vasectomy reversal when GA was the norm at this institution. Big mistake though. MD probably had not done a spinal for a while as I had 7 different puncture sites at 3 different interspaces. Plus, he used 20mg of Tetracaine!!!! Back to the ganglion cyst. I told the MDA that I wanted to see what Ketamine was like as I use this drug a lot in my practice. Also very interested in pain control post op and want the NMDA receptor effect going on. Forgot to purchase Delsym preop too. He was worried that Ketamine was going to cause me to have "flash backs" as he knew that I had been in Viet Nam. I assured him that I didn't think 30 to 50mg of Ketamine would be a problem and that with a little Versed, I'd be fine. He agreed. I gave myself the Versed 2mg as I was being pushed from preop to the OR. Don't remember getting on the table. Ketamine was started as soon as I entered the room. Don't remember them actually doing the Bier Block. Ketamine experience. Neither good nor bad. VERY unusual. Colorful. Shapes morphing from one shape to another. Not disagreeable nor pleasant. Have no interest in duplicating but would not object to it's use for me in the future. All I got was the Ketamine totalling 50mg and the Versed 2mg which was my wish. No propofol and no narcotic. Surgeon injected operative site with a little .25% bupivicaine during the closure. I remember voices but contorted as the procedure came to an end. I remember them showing me the culprit when I arrived in stage 2 PACU. I remember the tourniquet starting to become an issue as the case neared it's end and was aware that the surgeon said the tourniquet could go down for his PA to do the closure. I don't remember objecting to the tourniquet although I may have. I remember moving myself over to the PACU cart with minimal assistance and that my surgical arm was pretty useless at that point. I got a gram of IV tylenol intraop. Post op. I got no other drugs in PACU before going home in about an hour. I kept waiting for the pain to set in as the evening went on. NO pain...whatsoever!!! Took another 200mg of Celebrex that night and a dose of Delsym. Expected the first post op day to be rough or at least somewhat more painful but was pleasantly surprised when NONE was forthcoming. And, the pain from the cyst which I had grown accustomed was gone as well. Took another Celebrex and more Delsym upon waking and 2 regular strength tylenol. I had a script for Norco and have not used any. Overall, a very good experience and VERY surprised at the efficacy of our adjuncts. Today is 2nd postop day. Will take some more Delsym and Celebrex and will use tylenol only PRN. I know this is not an abdominal procedure but am still surprised at the abscence of pain with NO narcotic use at all. Hard to know what each contributed....the NSAID, the NMDA receptor, the tylenol and the local. A great example of preemptive analgesia. While I am what would be considered a pretty heavy narcotic practitioner, I do try to include as many adjuncts as possible in my daily practice. This experience has buoyed my belief in preemptive analgesia and the use of adjuncts.
Sorry for the length.