Castration Preference - General anesthesia (asleep) or Local anesthesia (awake)

[GenChick (imported)]

I did not know I could choose… I would prefer Local, but only if I can see clearly what is going on. No point of just laying there and staring at the ceiling.

[Woggler58 (imported)]

The question should specify which surgical route for removing the testicles is intended. It depends on the reason for the operation.

For suspected testicular cancer, removal through the abdominal wall's inguinal area is always used, the access cuts (one per testicle plus a long length of its attached vas) being similar to that used for repair of an inguinal hernia. Spinal or general anesthetic apply.

When other reasons for castration apply, removal of both testicles through one cut in the scrotum wall's vertical midline (or one cut each side of the scrotum) is typical and local anesthetic is often feasible, same as for a vasectomy.

[Peter47-NL (imported)]

In general I prefer a local anesthesia if possible. In case of castration this counts even much more. A castration is one of the most important events in a lifetime and I want to undergo that with full consciousness.

[Woggler58 (imported)]

A follow-up to my #12 above, quoting from a distinguished medical university hospital's patient-informing publication, the 2007 edition of the Johns Hopkins White Paper on Prostate Disorders. This on-topic excerpt pertains to the surgical option for eliminating testicle-produced testosterone from patients whose prostate cancer needs a whole-body deterrent to its growth. Digested somewhat, and with my edit in brackets, it reads,

"Surgical removal of the testicles, a procedure known as bilateral orchiectomy, is the easiest and oldest way to dampen testosterone’s [nurturing] effects on prostate cancer cells. The operation can be performed in about 20 minutes under spinal or local anesthesia, and the individual can usually go home the same day. Surgical castration involves making a small incision in the scrotum and removing each testicle. Neither the operation nor the recovery is painful."

I've had spinals for left-side inguinal hernia repair surgery (1978) and twice for insertion of 18 hollow needles through my perineum into my prostate for subsequent entry of a radioactive pellet as high dose rate brachytherapy (2007). I was unconscious only for the physically invasive part of those procedures. I have had three rectum-accessed prostate biopsies (2007, 2014, 2015) which cut 16 to 24 small holes through my rectal wall and deeply into my prostate; these followed local anesthetic to first, rectal wall, then into my prostate. All anesthetic uses I had seemed completely appropriate and unobjectionable.

[MrStehenbleiben (imported)]

First of all, I think that everybody must take the advice of a anesthesist or dr on how to sedate seriously. Every surgery and everybody is different.

They gave me a choice between General and spinal. I chose spinal for seven al reasons. First because it gives me a feeling of still having some control over it. Second was they talked me through the entire procedure so I knew exactly when the dr removed my left testicle. They even showed it to me after the removal. Third is because I have wannabe feelings for paraplegia. I had to get the longer lasting spinal so I got several hours to experience being paralyzed as a bonus upon my left orchidectomy.

Greets,

Mr Stehenbleiben

[ZeuterMe (imported)]

Local, or perhaps an aggressive local.

Conscious sedation freaks me out, leaving you unable to remember suffering, rather than being unable to suffer, and leaving you with the worst case of drunk talk you've ever had. General anesthesia has a small but nonzero chance of suppressing your breathing, leaving you dead or brain damaged.

Shit's sake, how long does it take to do? The consensus is available in veterinary medicine - 2 minutes for cats, about 10 for dogs - and even novocaine is adequate to keep you comfortable for that sort of minor surgery. I'd argue that root canals are more unpleasant, as the anesthetics used - and methods thereof - are known to be less effective than the novocaine used in soft tissues… and we don't usually knock ourselves out for root canals or tooth extractions.

If you're asking what I'd want if my ball pain eventually necessitated removal, I'd go with a valium, long-acting caine-family drugs (marcaine (http://www.drugs.com/pro/marcaine.html) is apparently the longest-lasting of those commonly available, and has a prominent painkiller effect, even once it's nominally "worn off" and sensation has returned), and a prescription for something opiate to be used only if advil is inadequate. Actually, marcaine looks really good for this kind of thing; I'll just paste this:

The onset of action with Marcaine is rapid and anesthesia is long lasting. The duration of anesthesia is significantly longer with Marcaine than with any other commonly used local anesthetic. It has also been noted that there is a period of analgesia that persists after the return of sensation, during which time the need for strong analgesics is reduced.

The onset of action following dental injections is usually 2 to 10 minutes and anesthesia may last two or three times longer than lidocaine and mepivacaine for dental use, in many patients up to 7 hours. The duration of anesthetic effect is prolonged by the addition of epinephrine 1:200,000.

[smoothie36 (imported)]

So far there have been 16 replies to this thread. Most favor a Local anesthesia. I certainly did, but it was not offered, so I had to go with General. I primarily wanted to be part of the experience rather than sleep through it. I had a Local for my scrotectomy, and found the experience very satisfying. I hope there are more out there whether castrated or not willing to put their two cents in on this preference issue. I am hoping more doctors would realize that orchiectomy is a straightforward procedure easily handled with Local anesthesia at an ambulatory surgery center.

[Hopeful1 (imported)]

Part of the thing with general is you need an anesthesiologist and an operating room so your cost goes way up. In my case though, one side would have to be inguinal and that would require general. So if their going to do one side, might as well do both at the same time. That would save the doctor about five minutes if I ever have SRS/GRS/GCS/GAS. I wish we as trans people could settle on one term.

[smoothie36 (imported)]

When I get twenty responses, I will post a summary of the comments and preferences. Thanks for all the inputs.

[Tante Wippen (imported)]

Having gone into cardiac arrest when the gas man turned on the halothane during a supposedly routine appendix operation, then having woken up to a severe pain in both the chest (due to CPR) and groin, I would suggest that general anesthesia is only used for major surgery. So for an operation such as castration it would be better to have a loca,l as the idea is to become balless not dead, plus a local allows you to fully experience and savour a unique one off life changing event. My own preference would apart from a local, also include one or more suitably placed cameras so that the whole procedure can be recorded for latter enjoyment.