What is the most pain you have ever felt

[phillysailor]

Not me, but a friend mouthed off to the gentleman administering the anesthesia prior to his hernia operation and woke up strapped down on the table to hear "let's begin" and was essentially awake for the whole operation.

I'd be astonished if that was intentional. I'd consider it a crime if it were, not just a civil matter. Patients pre-op are under considerable stress, have a variety of cultural and personal coping strategies, and we become tolerant of disappointing interactions, at least those who are successful.

Being awake during surgery can happen, but a number of errors have to be made and warning signs ignored. Paralytics can make it impossible for a patient to signal distress, and after induction & intubation a provider could fail to properly set the inhaled gases which maintain anesthesia during a case. But typically vital signs reveal a problem well before consciousness occurs. There are anti-hypertensive drugs which can blunt such reflexes, but man that's a horrible story and always a prime concern of providers.

It is interesting how the brain "fills in" gaps in time when under the influence of anesthetic agents... it is not uncommon for patients to be sedated and tolerating procedures well, even to the point of needing assistance maintaining their airway, to have some limited arousal at the end of the procedure and honestly interpret the experience as having been "awake the entire time."

There are production pressures which encourage providers to stop giving meds a few minutes before the end of the case, so that they are waking up just as the procedure finishes. That way a colonoscopy patient is opening their eyes a minute after the scope is out, for example, and not five minutes after they've arrived in the recovery area. Providers get really good at it, but there is variability in humans, so its an inexact science.

 

[phillysailor]

Cannabinoids taken frequently can increase anesthetic requirements dramatically, btw. We've had folks ultimately receive what seems like two or three times the total dosage requirement we'd otherwise expect.

So be honest with your anesthesia team! Always appreciate answers which reveal mistakes... had a kid show up who shook his head seriously and said he hadn't had anything after midnight. He had a breakfast sandwich before coming in, but nothing after midnight.



All the nurses memorized his face so as to warn their daughters to stay away from that numbskull.

 

[Ed Lada]

I think an elective Total knee replacement is pretty stimulating, newer adjunctive nerve blocking approaches can help. A good working epidural is still gold standard but can be a fiddle.

Because of my history of 3 pneumothoraxes (speaking of pain, lung surgery and pleurodesis is no fun at all), I had both of my knees replaced using an epidural and a Propofol drip. My only complaint was the damn operating table ain't exactly a Serta Perfect Sleeper, and the hammering and buzzing of the bone saw got a little annoying. When they were whacking the femoral part of the prosthesis in place, I felt the blows from the non numb part of my spine right up to the top of my head. I nicely asked the anesthesiologist for a little more Propofol and he turned up the drip and I nodded off for a blissful bit. I did like not having to deal with the usual hangover from a general, and the shorter stay in the recovery room. 2 hours later I got out of my bed and went down the hall on crutches to the smoking balcony. Gotta love German hospitals! It hurt like hell, but I wanted a cigarette dammit.

Have you ever tried acupuncture to manage post op pain? I had the same anesthesiologist for both knees a couple of years apart. He offered the acupuncture both times, the 1st time I declined and the 2nd time I tried it. He put a few needles in the ear on the side I was having the operation the morning of the procedure. I would say there were 4 or5 or so starting on the ear lobe and going up the ear. The doc told me to press on the one in the earlobe any time I needed more pain relief. I also had access to the normal opioid pain relivers if I wanted them. It might have been the placebo effect, but I found significantly less need for the opioids than I did for the 1st knee, and a total knee replacement is no picnic. They took the needles out after about 5 days.

 

[veni vidi vici]

When is curare used ?
I have a story and want to see if it matches up

 

[Code 2]

Smacking my finger with my waffle framing hammer comes to mind....

 

[P_Wop]

Apart from kidney stones (very painful, as above) and a few broken bones here and there, and some prostate and bladder cancer surgery, and extreme tachycardia (the cardiac surgeon remarked that even his Ferrari didn't do 240), I'd vote for my present affliction.

Acute peripheral neuropathy. It's just continuous pain, 24x7. There appears to be no cure. The stabbing in my toes and feet wakes me up at all hours and it makes walking a real challenge. It's in my fingers now: I can't even pick up a piece of hot toast, and typing is a misery. I take mountains of gabapentin, but the fizzing, stabbing pain just goes on and on.

It's not a 10 or even a 5 (except in the stabbings), but it just doesn't stop.

 

[phillysailor]

When is curare used ?
I have a story and want to see if it matches up

Curare is never used anymore. It's a neuromuscular blocking agent found on some African plants I think? But too many effects on blood pressure limited its use once newer, more selective drugs were manufactured.

We use two types of paralytics. Succinylcholine, or "SUX", causes every muscle to twitch once and then relax until it wears off in 5-10 minutes.

Rocuronium, vecuronium, pancuronium, cis-atracurium block muscle twitches for much longer, say 40 minutes to an hour or more at usual doses.

They are given at the beginning of a procedure to facilitate intubation (placing a breathing tube), levels may be maintained during the procedure with additional doses or an infusion, and are reversed at the end of the procedure, or you make bloody sure they've worn off completely. And you'd be advised to reverse them anyways.

 

[warbird]

Motorcycle. You would think tumbling and sliding down the road at 100 mph in a helmet (trashed), gloves (scraped through in places), and USMC camo utilities, would be pretty bad. You would think standing up to shake it off on a broken foot with abrasion, some to the bone, on arms, elbows, legs, knees, hands, ass and uniform hanging is shreds would be pretty bad. Shock kicks in pretty quick. What is the most painfull is the debreding the gravel and bits (scrub brush scrubing) of every abrasion (no pain killers) in the ER over a period of an hour or so and then having to return for a repeat every day for a week.

 

[veni vidi vici]

Curare is never used anymore. It's a neuromuscular blocking agent found on some African plants I think? But too many effects on blood pressure limited its use once newer, more selective drugs were manufactured.

We use two types of paralytics. Succinylcholine, or "SUX", causes every muscle to twitch once and then relax until it wears off in 5-10 minutes.

Rocuronium, vecuronium, pancuronium, cis-atracurium block muscle twitches for much longer, say 40 minutes to an hour or more at usual doses.

They are given at the beginning of a procedure to facilitate intubation (placing a breathing tube), levels may be maintained during the procedure with additional doses or an infusion, and are reversed at the end of the procedure.

I was working in the ER when a helicopter pilot was brought in with uncontrollable convulsions from a closed head injury. When the doctor called out for curare I did a double take thinking of Tarzan movies. It did bring the convulsions under control. I have no idea how things turned out for him after he was rolled out .

 

[Ed Lada]

I'd be astonished if that was intentional. I'd consider it a crime if it were, not just a civil matter. Patients pre-op are under considerable stress, have a variety of cultural and personal coping strategies, and we become tolerant of disappointing interactions, at least those who are successful.

Being awake during surgery can happen, but a number of errors have to be made and warning signs ignored. Paralytics can make it impossible for a patient to signal distress, and after induction & intubation a provider could fail to properly set the inhaled gases which maintain anesthesia during a case. But typically vital signs reveal a problem well before consciousness occurs. There are anti-hypertensive drugs which can blunt such reflexes, but man that's a horrible story and always a prime concern of providers.

It is interesting how the brain "fills in" gaps in time when under the influence of anesthetic agents... it is not uncommon for patients to be sedated and tolerating procedures well, even to the point of needing assistance maintaining their airway, to have some limited arousal at the end of the procedure and honestly interpret the experience as having been "awake the entire time."

There are production pressures which encourage providers to stop giving meds a few minutes before the end of the case, so that they are waking up just as the procedure finishes. That way a colonoscopy patient is opening their eyes a minute after the scope is out, for example, and not five minutes after they've arrived in the recovery area. Providers get really good at it, but there is variability in humans, so its an inexact science.

I had bilateral inguinal hernias repaired a few months apart. My good friend did the surgery at his outpatient clinic (That's how I met him.).

After the first operation, as the anesthesiologist was bringing me out of the anesthesia, I woke up much quicker than he anticipated. He used an endotracheal cuff rather then a full ET tube. As I was waking up of course I tried to take a deep breath. I didn't get very far, only what was in the tube and then nothing. It isn't a nice feeling not being able to breath I didn't freak out, and the doc immediately noticed and deflated the cuff and yanked it out and I took in a nice big breath of air. I don't think it took but a few seconds. The next time he made sure to not let that happen again.

A few years ago we had taken some friends to Nürnberg, one of my favorite cities in the world, I used to live there. We had walked a bit around town and into the evening, and going up a very gradual hill, I was a little short of breath. Having smoked for many years that wasn't at all uncommon with some exertion. All of a sudden, my breathing just stopped like somebody had shoved a cork in my trachea. No air, nada, zilch, nothing. Again, I didn't panic. I jut thought to myself the worst that would happen is I would pass out and then I would probably be able to breath again. I just relaxed and I started to breath again. Nobody even noticed what had happened. I don't know what caused it, it was so sudden. Maybe some kind of spasm is all I could think of. I was only a little short of breath, not not even close to heavy breathing let alone hyperventilating. It hasn't happened since that time.

 

[Ed Lada]

I'd be astonished if that was intentional.

That was my thought too.

Maybe just a BS story or a gross exaggeration.

 

[phillysailor]

I had bilateral inguinal hernias repaired a few months apart. My good friend did the surgery at his outpatient clinic (That's how I met him.).

After the first operation, as the anesthesiologist was bringing me out of the anesthesia, I woke up much quicker than he anticipated. He used an endotracheal cuff rather then a full ET tube. As I was waking up of course I tried to take a deep breath. I didn't get very far, only what was in the tube and then nothing. It isn't a nice feeling not being able to breath I didn't freak out, and the doc immediately noticed and deflated the cuff and yanked it out and I took in a nice big breath of air. I don't think it took but a few seconds. The next time he made sure to not let that happen again.

A few years ago we had taken some friends to Nürnberg, one of my favorite cities in the world, I used to live there. We had walked a bit around town and into the evening, and going up a very gradual hill, I was a little short of breath. Having smoked for many years that wasn't at all uncommon with some exertion. All of a sudden, my breathing just stopped like somebody had shoved a cork in my trachea. No air, nada, zilch, nothing. Again, I didn't panic. I jut thought to myself the worst that would happen is I would pass out and then I would probably be able to breath again. I just relaxed and I started to breath again. Nobody even noticed what had happened. I don't know what caused it, it was so sudden. Maybe some kind of spasm is all I could think of. I was only a little short of breath, not not even close to heavy breathing let alone hyperventilating. It hasn't happened since that time.

What you are describing is airway obstruction, and was probably related to settings of the anesthesia machine at the time. There are both mechanical ventilation settings and spontaneous settings, depending on whether on how deep the patient is, whether they are trying to breathe or not... you could've been transitioning from needing breathing done for you to taking breaths spontaneously. Pull against the vent and it would be as you describe.

Or, the spontaneous setting has a valve that applies resistance to exhalation to allow a bag to squeeze air into your lungs and the valve prevents it escaping until it exceeds that setting. It's helpful when providing breaths, but breathing against it is uncomfortable.

As to what happened to you while walking was quite likely a spasm of the vocal cords, or perhaps the physiological equilvalent of a short circuit closing them when they should be opening. Maybe some secretions got in there and triggered a brief laryngospasm.

Breathing too hard against an obstruction is scary, but breathing in against too much resistance is dangerous. Strong exertions can pull extracellular fluid into the alveoli (functional lung units), and essentially create the same conditions as drowning or heart failure.

 

[PurpleOnion]

I'd be astonished if that was intentional. I'd consider it a crime if it were, not just a civil matter. Patients pre-op are under considerable stress, have a variety of cultural and personal coping strategies, and we become tolerant of disappointing interactions, at least those who are successful.

Being awake during surgery can happen, but a number of errors have to be made and warning signs ignored. Paralytics can make it impossible for a patient to signal distress, and after induction & intubation a provider could fail to properly set the inhaled gases which maintain anesthesia during a case. But typically vital signs reveal a problem well before consciousness occurs. There are anti-hypertensive drugs which can blunt such reflexes, but man that's a horrible story and always a prime concern of providers.

It is interesting how the brain "fills in" gaps in time when under the influence of anesthetic agents... it is not uncommon for patients to be sedated and tolerating procedures well, even to the point of needing assistance maintaining their airway, to have some limited arousal at the end of the procedure and honestly interpret the experience as having been "awake the entire time."

There are production pressures which encourage providers to stop giving meds a few minutes before the end of the case, so that they are waking up just as the procedure finishes. That way a colonoscopy patient is opening their eyes a minute after the scope is out, for example, and not five minutes after they've arrived in the recovery area. Providers get really good at it, but there is variability in humans, so its an inexact science.

I can only relay what was relayed to me. It's entirely possible that his brain filled in gaps or fabricated some or all of it. It's also entirely possible that he was bullshitting.
He looks, speaks, and, to a degree, acts like Tony Soprano and is the type that gets aggressive when threatened. Prior to going under, he got scared and when the anesthesiologist came and gave his short "we're just going to x y z" speech, my friend started with "what do you mean X? what do you mean Y" and similar in an increasingly aggressive tone. The way that people who are uncomfortable with not being in control tend to act. It was obvious he'd scared and angered the poor anesthesiologist.
Based on his comments about how things were handled afterwards - wagons circled, information controlled, etc. there was a basis for legal action, but he chose not to pursue it.
Again, this all based on a conversation from 20 years ago and is based entirely on one person's grandiose story. Plenty of room for intentional and unintentional exaggeration, fabrication, etc.
Either way the story had the impact of making sure I'm always exceedingly polite to those performing work on me.

 

[phillysailor]

A really important aspect of the American Society of Anesthesiologists is the closed claims analysis of all lawsuits. It allows the society to discover common causes of negative outcomes, and make recommendations, guidelines, and drive technological changes.

End tidal CO2 monitoring and the pulse oximeter were, in part, driven by the need to be sure that patients are alive and safe while under anesthesia. Our machine design and operating protocols, drugs and dosages, emergency algorithms are continually updated through this professional feedback system.

It's one reason anesthesia malpractice insurance rates have steadily dropped over the decades as a fraction of overall costs.

 

[D.M.D.]

Two bone marrow extractions. Second one, the Dr. didn't take enough out, so he went back in.....THE most excruciating pain I have ever endured.

 

[ROADKILL666]

shoulder surgery at number one. Number two would be partially amputated finger

 

[CMcG]

shoulder surgery at number one. Number two would be partially amputated finger View attachment 570754 View attachment 570755 View attachment 570755 View attachment 570755

That brings back memories. I lost the top off the same finger. It got eaten by a big planer. Everything down to the first knuckle was chewed off.
Surprisingly it was not too sore at first, I just got angry and threw a few things around the workshop. The pain only came later in the hospital. I couldn't see what was happening and didn't have enough of the local language to ask what was going on, but it felt like he stuck needles down the whole length of the finger through the open wound. Twice
.
The finger got infected afterwards so I left it a little late to remove the stiches (didn't feel like going back to the doctor so it was going to be a DIY job). Eventually sucked it up and removed them with a Stanley blade in the workshop. That was agony.

second worst pain was the burns all over my back and arms that I got from drunkley jumping into a fire on a beach. Ended up on an 8 hour flight a couple of days later which I will never forget. 8 hours of pure torture unable to sit back or rest my arms.

Third worst was waking up the next day after being hit by a car (The second time in my life, and I was drunk both times). No memory of the incident, but my friend who was with me said I was thrown in the air and he thought I was dead because I didn't move for ages. Its worth noting that apparently my pants was down around my ankles because apparently I was doing the windmill in the middle of the road with my dick. I probably deserved getting hit. Took a few days to get over that. Hasn't stopped me stripping off when drunk though so I guess no lessons were learned that time.

 

[ROADKILL666]

That brings back memories. I lost the top off the same finger. It got eaten by a big planer. Everything down to the first knuckle was chewed off.
Surprisingly it was not too sore at first, I just got angry and threw a few things around the workshop. The pain only came later in the hospital. I couldn't see what was happening and didn't have enough of the local language to ask what was going on, but it felt like he stuck needles down the whole length of the finger through the open wound. Twice
.
The finger got infected afterwards so I left it a little late to remove the stiches (didn't feel like going back to the doctor so it was going to be a DIY job). Eventually sucked it up and removed them with a Stanley blade in the workshop. That was agony.

second worst pain was the burns all over my back and arms that I got from drunkley jumping into a fire on a beach. Ended up on an 8 hour flight a couple of days later which I will never forget. 8 hours of pure torture unable to sit back or rest my arms.

Third worst was waking up the next day after being hit by a car (The second time in my life, and I was drunk both times). No memory of the incident, but my friend who was with me said I was thrown in the air and he thought I was dead because I didn't move for ages. Its worth noting that apparently my pants was down around my ankles because apparently I was doing the windmill in the middle of the road with my dick. I probably deserved getting hit. Took a few days to get over that. Hasn't stopped me stripping off when drunk though so I guess no lessons were learned that time.

When I was taking the pictures the morphine had kicked in. Ahhh good times😵‍💫

 

[Titilingus]

The most pain for me was being burnt. I remember eventually getting to the operating theatre several hours later and them trying to get a line in. I watched as arms, no go, legs and feet, no go...listen son, I'm going to put a line in your neck...don't move. The weird thing is watching as they were cutting my skin hanging off my legs and arms before I was unconcious.
I honestly thought to myself, I going to die now and made my peace.

Several days later I woke in absolute agony to a beautiful nurse's face who was stroking my cheek (most of my body was bandaged), what is really weird was it was intensive care but I could see blue sky and sunshine streaming through the windows.
She pointed towards the bellows (life support) next to my bed and said "if you don't start breathing properly you will end up on this...". I remember the concern in her face.
I choose at that point to fight. I spent numerous weeks in intensive care and was eventually flown back to an intensive burns unit. It took several months for me to recover and the pain was so bad I would groan in agony day after day. I had a single hospital room and truly wished that if I could walk I would have thrown myself out of the window to the ground several floors below.
I would say the pain from burns, and breathing through burnt windpipe and lungs is the worst I have suffered.
At one point after several weeks I was lowered into an iodine bath, it's the only time that pain made me black out, I remember the nurses were more upset than me.
I've been shot (fucker found a 2 inch gap between front and rear body armour) and I would rate that 1 out of 10 in comparison to being burnt, which I would say is 10/10 pain wise.
To be fair though, I probably caused more pain for the nurses when my buddies turned up with a few hidden six packs and got me pissed and snuck me out of the hospital for few hours before getting caught.
So yes, burns, top pain in my book.

 

[Grande Mastere Dreade]

leading a floater of a race 3 hours long in 100+ except the last 6 inches..