Awareness during surgery


Hello Dr Bland.
Thank you for your continued dedication to understanding CTS and your compassion to your patients. I just had some questions about awareness during carpal tunnel release surgery. I was diagnosed with severe CTS in my right hand and mild/moderate in my left. On September 29th I had the carpal tunnel release on my right hand. I was given sedation fell asleep and when I awoke the surgery was finished. I felt everything went wonderful. I am slowly regaining strength and feeling in the tips of my fingers. On December 8th I had the release surgery on my left hand. It was with the same surgeon but with a different anesthesiologist. The anesthesiologist spoke with me in great detail and went over my records on what medication was given, how much and the outcome. I felt like I was well informed.
It came time to put the iv in. The right one went in easy but the left one was missed twice. The nurse said the Dr would have to put it in. I was very nervous after being wheeled into the operating room. To avoid more stress the anesthesiologist said he would give something to relax before he put the iv in. I quickly fell asleep. Then what felt like a few seconds later I felt the surgeon slice into my hand. While my impaired brain was trying to figure out what was going on I felt a second slice. I immediately start exclaiming,"Ow, ow, ow, ow!" The next thing I remember is something being pulled out of my mouth and the nurse telling me they just had to give me something stronger. I guess I was wheeled into recovery.
In the recovery room I asked the nurse what had happened. She told me that she didn't know and that she wasn't in the operating room. She handed me my clothing so I got dressed and was wheeled out to the car. My surgeon didn't come speak to me after the surgery as he did the time before. I felt as if everything was a little hush hush.

My question is how often does this occur? With all the surgeries you have done is there a certain percentage in which you've experienced the medicine doesn't work to fully numb the patient? I absolutely love my surgeon and his medical team but they are human. Could it have been an oversight by a team member? Or maybe it's something within myself and my physiology?

The information about the missed iv's may not be necessary. I just wanted to include any bit of information that might be helpful.
Currently my hand feels great. It's moving better than my right had was two days after surgery. I would just really like to know about the awareness during surgery. I could not find any information about awareness during carpal tunnel release surgery.


Most carpal tunnel surgery around here is done under local anaesthetic so there are no iv injections, no sedation, and patients are fully awake (and welcome to watch the procedure if so inclined). As a result of this it's hard for me to say how common such problems might be in other operating environments where sedation or full anaesthesia is used - though I am aware that there is a whole literature on the subject of retained awareness under anaesthesia in other forms of surgery. I do come across a few patients in whom the operation (done awake) was very painful. These are certainly not common and I think they fall into two groups. The majority are a result of the surgeon rushing into the procedure before the local anaesthetic has had time to take effect fully and I think that is why they are very rare in my local practice because I have a pretty good bunch of surgeons. However there may also be a very small number of patients who are resistant to the effect of local anaesthetics. Such patients also report a history of dental anaesthetics not working very well on them and it may be a familial trait - there is a report from a pair of twins with this history here on the website. In that latter case one would expect it to be a consistently reproducible difficulty with all procedures, rather than a problem for one hand but not the other, though when we were looking into it we did come across a suggestion that resistance to one local anesthetic may not carry over to resistance to another, chemically different, one in the same patient so that there would be a possibility of having different experiences on different occasions if a different drug was used.

I think to make any further comment on what went on during your operations one would need a lot of technical detail about the methods used. You would have to ask the anaesthetist what went on I think. JB

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