Was this reaction to local anesthesia normal?
October 13, 2017 8:47 AM Subscribe
I had local anesthesia for a minor surgery earlier this year, and I had an unpleasant, seemingly atypical reaction to it. I need to have another very similar surgery soon, and am wondering if I should be looking for a different doctor's office to perform it, or if this is within the normal range of things to expect during surgery.
Earlier this year I had a wide area excision for melanoma. The dr office told me it was a very minor surgery and would be over in 20 minutes or so, so I was actually not very anxious about it. I was expecting something similar to the biopsy.
However, not only was the surgery a gruesome, 45-minutes plus affair, I had a negative reaction to the local anesthetic (lidocaine without epinephrine, if I recall correctly). At first I noticed I was lightheaded and felt sort of pleasantly "high." Then the feeling dramatically deepened until I felt detached from reality, my extremities felt numb, and I had trouble moving and talking. By the end of the surgery I was involuntarily shivering all over.
When I first noticed my symptoms, I asked them if this was normal and they said it was not. So that freaked me out, and maybe contributed to making things worse (like a bad drug trip sort of thing). They called my partner into the room maybe in an effort to help relax me. They checked my blood pressure when the procedure was over and it was normal. The effects wore off later that evening, but in the meantime it was quite scary.
To their credit, they called me the next day to see how I was doing and also expressed concern during my follow up visit a week later to have the wound checked.
I need to have a second area removed in another wide area excision, and I'm leery of going back to this office. However, they are literally a mile away from my house, I now have a history with them and going back for this procedure with them would just be so much easier. Is what happened within the realm of normal? And if not, is there anything I can do to avoid having it happen a second time?
Thank you, Metafilter!
Earlier this year I had a wide area excision for melanoma. The dr office told me it was a very minor surgery and would be over in 20 minutes or so, so I was actually not very anxious about it. I was expecting something similar to the biopsy.
However, not only was the surgery a gruesome, 45-minutes plus affair, I had a negative reaction to the local anesthetic (lidocaine without epinephrine, if I recall correctly). At first I noticed I was lightheaded and felt sort of pleasantly "high." Then the feeling dramatically deepened until I felt detached from reality, my extremities felt numb, and I had trouble moving and talking. By the end of the surgery I was involuntarily shivering all over.
When I first noticed my symptoms, I asked them if this was normal and they said it was not. So that freaked me out, and maybe contributed to making things worse (like a bad drug trip sort of thing). They called my partner into the room maybe in an effort to help relax me. They checked my blood pressure when the procedure was over and it was normal. The effects wore off later that evening, but in the meantime it was quite scary.
To their credit, they called me the next day to see how I was doing and also expressed concern during my follow up visit a week later to have the wound checked.
I need to have a second area removed in another wide area excision, and I'm leery of going back to this office. However, they are literally a mile away from my house, I now have a history with them and going back for this procedure with them would just be so much easier. Is what happened within the realm of normal? And if not, is there anything I can do to avoid having it happen a second time?
Thank you, Metafilter!
Why do you think you have to go to a whole different doctor rather than just talking to the one you already have? Presumably they simply used a common or standard anesthetic and any other doctor would likely use the same one, so you'd likely have the same reaction. Why wouldn't you just ask them to use a different anesthetic for your next procedure, given that you had a bad reaction to the one they used last time?
posted by kindall at 9:05 AM on October 13, 2017 [2 favorites]
posted by kindall at 9:05 AM on October 13, 2017 [2 favorites]
Response by poster: Kindall, because I've had local anesthetic umpteen times for dental surgery and have never had a reaction like this, I was wondering if it was something the dr this time had done wrong.
posted by whistle pig at 9:09 AM on October 13, 2017
posted by whistle pig at 9:09 AM on October 13, 2017
If possible, I would talk to the doctor about your previous reaction and ask what they can do to mitigate the risk of it happening again (a different type of anesthesia maybe? - no idea if that's possible). I'd base my decision off of how the office handles that discussion.
posted by insectosaurus at 9:15 AM on October 13, 2017 [2 favorites]
posted by insectosaurus at 9:15 AM on October 13, 2017 [2 favorites]
This sounds somewhat like a reaction to epinephrine - are you sure it wasn't lidocaine w/epi? May be something to bring up to your doctor.
posted by tatiana wishbone at 9:18 AM on October 13, 2017 [4 favorites]
posted by tatiana wishbone at 9:18 AM on October 13, 2017 [4 favorites]
Hmm, I'm not an expert but have worked in an Ob/Gyn OR for many years. It doesn't sound like a true allergy, especially since you say you've had locals for dental surgeries without problems previously. If there's no epinephrine, I would guess that you maybe had too much lidocaine and that caused the reaction.
Depending on how large the excision was, it seems plausible that this could happen, especially over 45 minutes. That said, I think it's worth talking to the same office and discussing the reaction you had and requesting an alternate medication (there are many).
Also, I'm not sure of the location and size of your excision, but if it's another 45 minute long procedure, might you ask for some sort of sedation? (Maybe a twilight/moderate sedation, or even nitrous?) 45 minutes is a long time to stay still and calm when someone is slicing bits of you out. (I say that in the most compassionate way possible!) I've had a couple of simple mole excisions done under local and none of them took more than 5 minutes. 45 sounds like a long time, especially given your experience with this last round.
Hope your next go is a bit better.
posted by stillmoving at 9:20 AM on October 13, 2017 [10 favorites]
Depending on how large the excision was, it seems plausible that this could happen, especially over 45 minutes. That said, I think it's worth talking to the same office and discussing the reaction you had and requesting an alternate medication (there are many).
Also, I'm not sure of the location and size of your excision, but if it's another 45 minute long procedure, might you ask for some sort of sedation? (Maybe a twilight/moderate sedation, or even nitrous?) 45 minutes is a long time to stay still and calm when someone is slicing bits of you out. (I say that in the most compassionate way possible!) I've had a couple of simple mole excisions done under local and none of them took more than 5 minutes. 45 sounds like a long time, especially given your experience with this last round.
Hope your next go is a bit better.
posted by stillmoving at 9:20 AM on October 13, 2017 [10 favorites]
I've had a similar reaction under laughing gas during a dental procedure. The dosage was changed and the feelings went away.
The whole point of anesthesia is to make you comfortable. Talk to your doctor about it. There are lots of options out there and you should feel calm if you are aware.
posted by AlexiaSky at 12:24 PM on October 13, 2017 [1 favorite]
The whole point of anesthesia is to make you comfortable. Talk to your doctor about it. There are lots of options out there and you should feel calm if you are aware.
posted by AlexiaSky at 12:24 PM on October 13, 2017 [1 favorite]
I know exactly what you are talking about! I had this same exact reaction twice. It's from amoxicillin, the antibiotic they administer along with anesthesia to lower the risk of infection. For what it's worth, for me, once the shakes and the depersonalization are over - which takes about an hour - there are no after effects of any kind.
(Once I knew, I told the nurse prior to a procedure that I don't do well on amoxicillin and they gave it to me anyway which makes me wonder if it's somehow packaged together with some common anesthetic or automatically included in whatever processes that are typically followed during surgery. So you may want to have a thorough discussion before your second procedure.)
Something interesting about the amoxicillin reaction: I had bloodwork done once where everything was excellent except higher than normal bilirubin. I've looked it up and turned up a genetic variation (I since forgot its name) that results in inability to process amoxicillin, high bilirubin and low cholesterol. I have all 3 of these so I presume I have the mutation - you may have it as well. It's found in 5% of the population so not that uncommon. Wikipedia said it's not considered a "disorder" since it's harmless other than a few quirks such as mentioned above.
I should probably clarify that the first time I had the reaction I took the antibiotic orally via a pill, and the second time it was injected during surgery. So it's amoxicillin, not the surgery itself.
posted by rada at 4:13 PM on October 13, 2017 [2 favorites]
(Once I knew, I told the nurse prior to a procedure that I don't do well on amoxicillin and they gave it to me anyway which makes me wonder if it's somehow packaged together with some common anesthetic or automatically included in whatever processes that are typically followed during surgery. So you may want to have a thorough discussion before your second procedure.)
Something interesting about the amoxicillin reaction: I had bloodwork done once where everything was excellent except higher than normal bilirubin. I've looked it up and turned up a genetic variation (I since forgot its name) that results in inability to process amoxicillin, high bilirubin and low cholesterol. I have all 3 of these so I presume I have the mutation - you may have it as well. It's found in 5% of the population so not that uncommon. Wikipedia said it's not considered a "disorder" since it's harmless other than a few quirks such as mentioned above.
I should probably clarify that the first time I had the reaction I took the antibiotic orally via a pill, and the second time it was injected during surgery. So it's amoxicillin, not the surgery itself.
posted by rada at 4:13 PM on October 13, 2017 [2 favorites]
> Sounds to me like you had a vasovagal response.
I had exactly the same symptoms as OP did when I was being prepped for my first cataract surgery, and it was diagnosed as a vagal response. The triggering event was inserting the IV needle, which at the time was not connected to anything at all. This led to a delay before the operation while they provided me fluids and sedative, an oxygen feed to my nose, informing me of what they were doing and continuing conversation with me to keep me awake, and brought my partner in for comfort (who later told me they were worried because my legs were unnaturally cold). While this was going on they were honestly explaining to me me that I was having a vagal response. They said that this is common reaction people have to needles, and that they have a lot of experience handling this reaction and that it's easily dealt with.
For the second surgery, the nurse was aware of my vagal response to the first prep, and so she maintained a steady conversation with me while having me breathe in through the nose, out through the mouth, in a steady pattern. And since the second surgery was the same operation as the first (which is done under sedation but without anesthesia), I had less anxiety about what I would be experiencing. I did not have a vagal response during prep for the second surgery.
Whether vagal reactions in these situations are common and whether they're easily dealt with might have been white lies the staff told me, but the staff were not strictly wrong either, because at no time did they say anything that would cause me to worry more; doing so would have been the negative reinforcement they were working to avoid. This is an emotional labor aspect of care that seemed to be missing in OP's situation.
OP: Before your second operation, raise the issue of the reaction you had, ask what had happened, and ask what can be done (both on your part and theirs) to prevent it happening again. If whatever you experienced can be ameliorated, it's a good time to establish what that is. Hopefully something as simple as breathing exercises can help, but obviously your caregivers are in a better position than we are to diagnose what happened, and they should also be in a better position than us to discuss how to avoid it.
posted by Subaru drwxrwxrwx at 5:49 PM on October 13, 2017 [1 favorite]
I had exactly the same symptoms as OP did when I was being prepped for my first cataract surgery, and it was diagnosed as a vagal response. The triggering event was inserting the IV needle, which at the time was not connected to anything at all. This led to a delay before the operation while they provided me fluids and sedative, an oxygen feed to my nose, informing me of what they were doing and continuing conversation with me to keep me awake, and brought my partner in for comfort (who later told me they were worried because my legs were unnaturally cold). While this was going on they were honestly explaining to me me that I was having a vagal response. They said that this is common reaction people have to needles, and that they have a lot of experience handling this reaction and that it's easily dealt with.
For the second surgery, the nurse was aware of my vagal response to the first prep, and so she maintained a steady conversation with me while having me breathe in through the nose, out through the mouth, in a steady pattern. And since the second surgery was the same operation as the first (which is done under sedation but without anesthesia), I had less anxiety about what I would be experiencing. I did not have a vagal response during prep for the second surgery.
Whether vagal reactions in these situations are common and whether they're easily dealt with might have been white lies the staff told me, but the staff were not strictly wrong either, because at no time did they say anything that would cause me to worry more; doing so would have been the negative reinforcement they were working to avoid. This is an emotional labor aspect of care that seemed to be missing in OP's situation.
OP: Before your second operation, raise the issue of the reaction you had, ask what had happened, and ask what can be done (both on your part and theirs) to prevent it happening again. If whatever you experienced can be ameliorated, it's a good time to establish what that is. Hopefully something as simple as breathing exercises can help, but obviously your caregivers are in a better position than we are to diagnose what happened, and they should also be in a better position than us to discuss how to avoid it.
posted by Subaru drwxrwxrwx at 5:49 PM on October 13, 2017 [1 favorite]
From Wikipedia: "Common side effects with intravenous use include sleepiness, muscle twitching, confusion, changes in vision, numbness, tingling, and vomiting.[3] "
This sounds like it what happened to you.
Maybe in your case, although it wasn't given IV, it was given in high enough quantities topically that it had a similar effect?
Drugs are drugs, and in some cases, differences in the quality of administration (topical, IM, IV, ingestion etc.) can be overcome or overwhelmed by quantity and time.
posted by soylent00FF00 at 6:15 PM on October 13, 2017
This sounds like it what happened to you.
Maybe in your case, although it wasn't given IV, it was given in high enough quantities topically that it had a similar effect?
Drugs are drugs, and in some cases, differences in the quality of administration (topical, IM, IV, ingestion etc.) can be overcome or overwhelmed by quantity and time.
posted by soylent00FF00 at 6:15 PM on October 13, 2017
I don’t know what happened to you, but going to another doctor will probably not help. It appears that your current practice was diligent and appropriate when it came to managing an adverse event. They should have all the information about what was used and can most appropriately adjust the dose or ingredients. If you show up at another surgery with the history as you have described here, it’s more difficult for the doctor to assure you that they are doing the procedure differently.
Speculating that this is due to amoxicillin is baseless as amoxicillin is not routinely used for skin procedure infection prophylaxis.
posted by chiquitita at 7:06 PM on October 13, 2017
Speculating that this is due to amoxicillin is baseless as amoxicillin is not routinely used for skin procedure infection prophylaxis.
posted by chiquitita at 7:06 PM on October 13, 2017
Response by poster: Thanks everyone. Consensus seems to be that I should at least talk to them before writing them off altogether. I wanted to get a sense of whether this was in within the realm of normal medical practice. Honestly when no one was able to tell me either during the procedure or in the follow-up visit what might have caused my reaction I thought that perhaps they gave me an accidental overdose of the anesthetic. I had read that anxiety could trigger a reaction like this but oddly enough was not feeling anxious in the least prior to going into the surgery. So who knows?
posted by whistle pig at 7:25 PM on October 13, 2017 [1 favorite]
posted by whistle pig at 7:25 PM on October 13, 2017 [1 favorite]
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