Anesthesiologist suggestion for excisions

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Tail Bone

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Hi everyone, This is an E-Mail reply I received in July 2004 from an anesthesiologist. The CAS have not replied me yet.( Canadian ansthesiologist society).

This is My Question.....
Hi there, I hope someone can answer this concern for me.

I have been diagnosed with pilonidal disease. I've just seen 1 gerenal surgeon, who suggested for excision with marsupilation, open healing.

He says that the section to be excised is approx the size of a man entire thumb and a little deeper. 1 inch wide, 3 inches long and 1 inch deep, right down the middle. ( Pilonidal cyst are usually located at the tailbone area of your butt)

He is suggesting only the use of local anesthetic, infiltrating the area with local, while wide awake, no sedation zippo! He said that it is not mandated to use anything either than the local shots.

I am 28 years old, don't smoke. drink, drugs, not on any medication, ect. I'm in excelent health with no known allergies.

Is this method really the norm? Do I have a say to the type anesthesia to be used? Will the use of only the local be very painful?
What would you recommend for the excision of a pilonidal cyst?

What really concerns me is that a local health guide in my province states that excision of a pilonidal is typically done under general anesthesia.

Who's right? Who's wrong?

I would really appreciate your input on this matter.

Thanks.

This is His Reply...

The choice of anesthesia for any procedure certainly is a discussion between the surgeon, the patient and the anesthesiologist. You DEFINITELY have a say in the type of anesthesia to be used.

Local anesthesia is an option for this type of procedure, but as with any procedure the patient must be motivated to have that type of anesthesia. Certainly local anesthesia will be very uncomfortable - a number of injections will be required for the area to be numb and the injections themselves are very painful.

Since you are young and healthy, you have many options for anesthesia available to you. Possibilities in addition to local only include local with sedation, spinal anesthesia and general anesthesia. In my experience the most common are local with sedation or general anesthesia - although a large proportion of patients also choose to have a spinal. I would say that local alone (without sedation) is the least popular choice. I also believe it is the poorest choice - with all the other methods providing a superior experience.

Hope this helps.

Paul H. Ting, M.D.


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Paul H. Ting, M.D.
 
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