While I was sharing a four bay ward post hip replacement, two ladies - who had a total knee replacement and the other a half knee replacement - told me that although, like me, they had a spinal block plus sedation they both could hear the sawing and hammering and what the surgeons were saying…. but of course couldn’t speak. How dreadful!! Luckily they didn’t feel any pain during the surgery.
This would have freaked me out…. I really don’t understand why they were able to hear. Whenever I have had a spinal block plus sedation I certainly did not hear any tools being used in the procedure nor the voices of the surgeons.
Just wondering if anyone has had this unusual and unfortunate experience?
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I’m having knee done I’m having with a spinal block, not sure about the sedation and I’ve been warned by people who’ve had the same op that you can hear hammering and sawing.
Well I had never heard of this happening at times until last week! It must be rather scary to hear without being able to let them know…. Let’s hope you’ll be spared that form of “entertainment “. Good luck.
Just asked husband who had a spinal block for his new hip - when pushed he seemed to think he could hear vague noises but was so spaced out he didn’t notice them. I’ve met a lot of people of various ages who’ve had nerve blocks for surgery and none of them have ever mentioned anything like that, they’ve all said it’s the way to go for an operation.
I know I’ve not had it done myself but I think I’d tend to take it with a pinch of salt- you certainly wake up feeling an awful lot better than you do when you have a general anaesthetic.
One patient was very clear about what she heard, even named the music the surgeon put on, in the background. As I got to know her a little better over 2 days I can assure you she’s a logical type of person. We’re keeping in touch. The other patient was also quite clear in what she heard. They had other operations in the past and never experienced that. Strangely enough this happened when the surgery was performed by the same surgeon, same anaesthetist two days apart. I agree spinal block is preferable to full anaesthesia unless that is absolutely necessary,
I wonder if the surgeons were cutting back on the amount of sedation they were using?
I think if I were those ladies I would bring it up with PALS or the hospital management, more so because it was the same surgeon and anaesthetist combo - for the sake of other patients the hospital need to be informed.
They must have used enough anaesthetic for the patients not to feel pain, thank goodness for that. I suppose if you think about it when C sections done under spinal block the mother is aware of what is happening and can talk to the doctors - I’ve heard them say they are aware of the ‘pulling’, on the other hand you do hear of people being aware of what is happening during operations done under a general operation. Grim isn’t it!
I don’t know if they will mention it to Pals. I will ask the person I am keeping in touch with whether she will mention this to the surgeon when she sees him again. That would be interesting I think!
Am pretty sure the anaesthesia was judged to be safe in that patients would not feel any pain, Very pleased I didn’t experience it though.
I have had both knees replaced and during the second I was awake for a time and concious of things happening but because of the sedation you don’t really care !!
Rheumatoid arthritis is such a debilitating problem… it destroys one’s life and it is difficult remaining positive at times… so frustrating losing one’s ability, independence and mobility. Thinking of you and sending love ❤️
My first replacement I heard nothing. Other hip I semi woke up and spoke to the anaesthetist then went back to sleep. I could hear background drilling and I mentioned it afterwards it was Surgeon drilling my hip😀 I was so chilled I didn't care. It might sound freaky but it wasn't. Within a couple of hours back on the ward and ate my tea
These two ladies had sedation. Since I replied to your post I’ve read several posts where this occurrence has been explained so no need for anyone to worry about it since pain and fear are not experienced.
Perhaps some "insider" information....I was a theatre Nurse for 31 years and participated in hundreds of joint replacements, mostly spinal anaesthetics, but some general anaesthetics as well. Contrary to fictional medical shows on the telly, surgeons have little or no participation in the type of anaesthetic or the "depth" of sedation. This is the function of the anaesthetist in the theatre. They will discuss spinal vs. general (general is usually used if the operation is expected to be prolonged, as spinal only last for 2-3 hours maximum), as well as discussing how awake the patient would like to be. Some patients like to converse and ask questions throughout, whereas others don't want to hear a thing. The level of sedation may increase and decrease throughout, depending on a myriad of variables - what your heart rate and blood pressure are, the amount of bleeding encountered, your tendency to obstruct your breathing with heavy sedation, the list goes on. What I'm trying to say is that everyone's experience may be different, but all anesthetists I have ever worked with have your best interests at heart, and certainly safety Wed trump a "wonderful experience" every time. If anyone has been very distressed by their level of awareness in the past, it would be very beneficial during your anaesthetic consult to indicate your preference for deep sedation, barring safety issues. As well, each anaesthetist has their own routines and safety guidelines, and some are more cautious than others. Hope this gives some insight into "what goes on during your knee or hip replacement".
I am so glad to hear this ! I am on the list for a new hip and am nervous about it, reading helenw7 post made me worry even more ! But your post has made me feel better ,Thank you x
Annpisan, thank you so much for this logical explanation. Of course I am aware the anaesthetist makes all the decisions regarding what he will use and how much according to each individual patient. The patient’s safety is always at the helm of his/her decision naturally. I understand they may increase the sedation during the operation if judged necessary or perhaps give less sedation because of the patient’s medical issues. Nothing is ever static. One of the ladies had a heart condition and the other one was 86 years old, so more fragile. I never doubted they always do their best. The surgeon does the “mechanical “ bits…
I much prefer the spinal block plus sedation to a full anaesthetic as it always took me ages to come round. Thanks for explaining.
Spot on Annpisan thank you for that insight - the surgeon operates - it’s the anaesthetist who is responsible for putting you out and bring you back. What a responsibility! Actually we’ve been watching the ‘challenging’ operations that are taking place in Addenbrooke’s - quite amazing, let’s you see what everyone does in the operating theatre. That is amazing.
We’ve known quite a few people who have had operations with nerve block and sedation. When my other half had his hip replacement done he didn’t find out until after he spoke with the anaesthetist that morning that he was suitable for a nerve block. We both had our fingers crossed that he would have it done that way. Fortunately it was. I think like you say it’s probably best to say you would prefer to be sedated enough not to hear what’s going on.
It does sound frightening but now we understand that the patient is so “relaxed” and in NO PAIN that they don’t feel fear. So please do not worry. Please read the post from Annpisan explaining what it means. The ladies who mentioned what happened told me they didn’t feel pain neither fear. That’s reassuring.
Still a no from me. I can't even have my cuticals cut. I can guarentee you I would be feeling fear. I am totally awful with anything grousome. I can't watch casualty and I know it's not real. lol.
oh… I feel for you but really you would not feel any pain, they are constantly monitoring you… have faith in them. It would be so much better for you to have a spinal block plus sedation… easier and quicker to recover… However it’s your choice but please try not to worry unduly… I know it’s not easy but it will be fine.
Evie3, please read my reply to Angjoplin above and the post written by Annpisan which should alleviate your fears. So please go ahead with your operation without fear, it will be fine. I was simply surprised when I was told about such an experience but now I understand this can happen quite often depending on each individual patient’s circumstances I am not at all concerned. Good luck with your operation.
I was an orthopaedic nurse and ward sister for over 30yrs, so have nursed many many joint replacements. As Annpisan says the level of sedation offered varies greatly, and each patient is individual. I’ve had many who don’t want much sedation, and can be aware of everything going on. Some would return with funny stories told over the theatre table, whilst others opt to be heavily sedated. In all my years I never met anyone who was distressed by their experience. Some are apprehensive going in, as they would rather have a GA, which is rarely used these days. However afterwards they agree it was fine, and enjoy eating and drinking shortly after returning to the ward. It may be that both these patients opted for a light sedation, hopefully neither were distressed by the experience.
So glad you’re not fearful now. How reassuring it is to understand what’s happening. Ignorance makes one fearful. Perhaps it might be a good idea if they included a small paragraph in the pre assessment booklets, explaining that in some circumstances the patient may hear what’s happening but that they won’t feel pain nor fear. However some people might still panic. So relax. xx
Hi Maureen and thank you for your post backing up that of Annpisan. Fear comes from ignorance so once one understands how things work there’s no need to be fearful. One of the ladies had a heart condition so perhaps the sedation was minimal and the other lady was 86 so there again the anaesthetist probably decided a mild sedation was preferable for her safety. Once one understands there is no need to fear. Both of these ladies said they felt no pain and didn’t feel distressed and couldn’t care less.
My husband was in agony and could hardly walk because of the pain in his hip, he said afterwards he put up with it for so long because he was terrified to have the operation, eventually he had no option but have a hip replacement. We had heard so many positive stories from people who had a nerve block and sedation he was desperate to have it done that way. I was there when he came back to the ward - fully awake and aware and hungry! Ten minutes later the physio arrived and had him out of bed and walking - I’m a wimp, I went home at that point. That type of surgery is wonderful - if you meet the criteria for having it then go for it.
It’s a bit like cataract operations - over and done with in no time with a local anaesthetic.
when I first looked after hip replacements in the 80s, they stayed in hospital for 3 weeks. When I retired in 2018 it was 3 days. It’s remarkable how things have progressed, and it is very successful in the majority of cases 🤗
I know, we were talking in Pilates the other day about how ‘bed rest’ used to be the standard treatment for back problems in days of old - my Pilates teacher is a physiotherapist.
Not moving is the very worst thing I can do for my dodgy back. I had my son by emergency C-section in 1976 and I was kept in for ten full days - it was ridiculous, I used to make my bed etc in the hope that if that would encourage them let me go sooner but nope - it had to be full ten days. Nowadays they are out same / next day C section or not. I suppose they want to avoid infection.
My husband had two nights in hospital for his hip replacement by the time he did physio, he could have got home a night earlier but by the time he saw the doctor it was too late to have his drugs made up so I collected him first thing the following morning - he was fine - believe me I was more nervous about him than he was.
It was the same with his gall bladder last year - I dropped him at 7.00am at the day surgery unit one Thursday and collected him that same evening - minus his gall bladder. Our next door neighbour is an anaesthetist at the same hospital and when we met her a couple of days later when we were out for a walk she couldn’t believe he was up and out and looking great.
Where would we be without our doctors and nurses - well without all of our wonderful hospital staff?
definitely agree. I have ankylosing spondylitis , and even when in a flare it’s essential to do gentle stretches. As you say years ago everyone was advised to rest backpain, surgery etc. However they developed more complications whether that was infections, or DVTs, or even muscle weakness due to being inactive. The only issue now is the government haven’t ensured staffing levels reflect the higher level of care required, that it’s become pretty much like a production line. I regularly worked 13.5hr shifts getting no breaks and grabbing a sandwich or coffee behind the desk. It’s sad that management don’t really care for the caring profession. I don’t mean clinical management but the ones sitting in carpet land, who attend meetings with lunch provided, but come away with no plan. I used to have a senior natron, junior matron, bed manager, clinical services manager, business manager and transport manager pull me away from giving care to ask the same questions. How many beds, how many admissions, how many discharges. If I didn’t have enough discharges I had to go through each patient justifying why they couldn’t go home. Oh and they came separately. Get rid of most of them and use the money saved to pay nurses a decent rise. Due to paying the price for austerity my pension is 5,000 less than it should have been, had it kept up with inflation as what happened when labour were in power. I’ll get off my soap box now 😂😂
Absolutely agree all those “managers” are totally unnecessary and a waste of time and money which should be directed to the caring staff.
I was really shocked and upset observing how the nurses were put under enormous pressure to deliver, deliver and deliver more! One nurse helped me on discharge on Sunday evening…. It was 8 pm…. Had been there all day and had no lunch just a few biscuits! They’re exhausted and demoralised. It’s inhumane and not safe for patients. Mistakes will be made. I really felt upset and sad for them.
Thankfully the nursing staff know that the public understand the pressure they are under. They are usually late off, writing up their notes. As we’re always told if it’s not written it didn’t happen. Sadly there is no time on shift to write the notes up. Drs are a different breed and will happily head off when their shift ends without writing their notes up. I’m sure the nurses looking after you and your husband could see your empathy for them 🤗
Yes I did notice that wonderful nurse sitting down at a desk in a small office at the end of the corridor typing madly… I agree it’s different for doctors… always has been. Whenever I expressed my genuine thanks to the nurses they looked so pleased… they need more of that, more pay but most of all better working conditions. Working conditions should be the priority.
What a difference…. I agree the least time spent in hospital the better as long as things are “normal” post surgery and as long as there’s someone to help at home during recovery. The risk of dislocation is a concern with hips and infections but that applies to other operations too. I know a man who had a hip replacement operation 6 years ago … developed an infection and has to be on antibiotics since then…. Sometimes on a drip other times has to stay in hospital.. he sometimes has incredible nose bleeds and then must be rushed to hospital. He suffers a lot. He’s in his 80s and his wife in her 70s… He’s still very positive but that’s because his wife is always with him and looks after him. I can imagine it must be so hard living like that… The consultant doesn’t know what else they can do now…. It’s a bit like the end of a line.
Thankfully infection rates are much lower these days, but can be catastrophic when they do occur. Usually they have to remove the new hip for infection to resolve. The issue is the body sees it as a foreign body, much like when you get a splinter in your finger and it gets red and angry at the site. The same process can happen in joints and trigger infections. Hopefully they manage to get on top of his infection. It’s much more serious than chest infections and utis as it can result in osteomyelitis which is impossible to resolve 🤗
It’s quite frightening how fast you can go from being a healthy active person to being someone with big problems. When you are young you never even think about it, then as you get older you think it won’t happen to you, then when you get even older you realise it might well happen.
If we’re lucky to live long enough then old age is unavoidable. Some older people are fairly lucky in that their health is quite reasonable allowing them to remain active, with some limitations, for a very long time. I have always envied such fortunate people. When one loses one’s good health, especially when still rather young, it is devastating.
It might sound quite daft but it’s only when you lose use of your legs, hands, eyes, etc. that you begin to realise how important all these are to our daily lives. Until this happens we take rude health for granted. It is quite normal not to think about such problems when young and healthy.
Agree with Annpisan and maureengibson here. I too was a senior sister and worked in orthopaedic theatres and you’ve had both insider and accurate info about what happens between anaesthetists (experts in their field) and surgeons (experts in their field). Worry not, we’re lucky to be living now with amazing techniques and anaesthetics which even a few years ago were unheard of.
Thank you for confirming what Maureen and Angpisan have already explained. Once one is aware and understands there’s no need for fear. I was most surprised to hear those stories because I have never experienced this situation before. It’s reassuring to know one doesn’t feel pain nor fear when it occurs and why it might occur.
Indeed we are so lucky to have all these sophisticated procedures and efficient professionals nowadays.
I had spinal with sedation for hip replacement and would ask for lighter in the likely event of a knee replacement...because I'm curious about these things. I did hear some fine hammering.I also had spinal for hysterectomy some years ago and was aware enough to ask to be topped up..that op was a bit much.
It's worth a discussion with your anaesthetist beforehand.
I was wondered if you could wear an iPod. I had to have an apisectomy and dental surgery isn’t my favourite thing so I took my iPod and asked if I could wear it. No problem so I listened to my favourite music and ignored what was go8ng on in my mouth.
I had my knee replacement 20 years ago with spinal block, and yes, I could hear the hammering and sawing. I didn't feel a thing and I remember thinking that if they could do this to my knee without me feeling it, why couldn't the dentist do better with pain control!
I could have spoken if I wanted to, but I didn't want to distract the doctors at their work. I did actually fall asleep for a while during the surgery.
How amazing ! I wasn’t aware this could happen so was wondering if anyone else had such an experience and why it could happen. How sensible not to want to distract the surgeon with a chit chat,,.. Hope the knee is still strong and doing well.
This is turning out to be such an interesting post isn’t it. We’re so lucky to have input from maureengibson and Annpisan and everyone who has had first hand experience.
I suppose they have been doing C sections by spinal block for many, many years and the mother is awake and able to speak. Unfortunately my c-section was done in an emergency and I’d already had loads of pethedine so the full general it was for me. Not a pleasant thing to come round from.
Indeed it is! However I didn’t expect to create such a stir and least to frighten people. I was simply just surprised when these 2 ladies spoke of their experiences…. having never experienced this myself nor heard about it until last week.
It might be a good idea if there was a brief note added at the end of the pre op assessment booklet they give us, to let us know this is a possibility but that people need not worry, no pain, no fear and in good hands. Just my opinion though.
It is most reassuring that nurses who worked in operating theatres were able to explain what and why this phenomenon can happen,
When i had my knee replacement a few years ago, I have to admit I found it fascinating. I could hear all the hammering and and could see the team but not what they were doing, I heard the staples being put in so knew that they had nearly finished. A few years later I had an angiogram which was even more fascinating as you could watch them threading a fine probe through a blood vessel into the heart on a huge screen!
Perhaps teaching health for many years made this more interesting to me!
I had both knees replaced eleven years ago.I was aware of drilling,sawing and it did not bother me at all.Ifelt relaxed and in good hands.I fell asleep on and off during the ops.When in recovery room i was alert but other patients were still groggy.I felt no pain that was all i cared about at the time.When i had both hips replaced2021/2022 i was out during surgery and woke up going along to recovery room.We are all individuals and experiences will vary.I find watching ops on tv fascinating.My husband is the opposite he does not care to look finds it horrible.Hope your recovery is going well.
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Knee replacement
not the news i was expecting :-(
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