Can you really be pain-free and play mobile games while undergoing surgery? Why yes.

So a funny thing happened last week - I went viral (again!). Well, mini-viral, at least. Allow me to explain.

It all began when a colleague of mine told me of a case she had done the previous day. The young male patient was being operated on for a fracture of his leg. She had taken his picture (with permission) during the surgery and I asked her to share it with me to put up online.

Well, as you can see in the image above, the orthopedic surgeons are busy operating on his broken leg on one side of the screen. On the other side of the screen, the patient is happily playing the popular mobile game, Candy Crush even as the surgeons operate on him.
I received a lot of comments on social media after sharing, filled with surprise about how it was possible.

"Can you really be so pain-free and actually relax and play games while undergoing surgery?" so many asked.

Twenty-fours later, I would find out that articles based on the picture had made their way to the very popular Malayalam magazine, Vanitha as well as a Hindi news website, Hindusthan News.

Personally, I was surprised that the majority of the general public was not aware that such a thing as spinal anaesthesia existed. But then, I was thinking as an anaesthesiologist, not a regular everyday Joe. And I think it is important to let you know just how far we have come from the days when I would have had to strangle you unconscious so that the surgeon could operate to save you!
I will try to keep it simple...

What the patient in that picture received is what we call Spinal Anaesthesia. 

• In this, a needle is introduced into your back and at a specific point, we give a drug which will render your lower limbs (and abdomen, if needed) totally numb - you feel no pain and you cannot raise your legs. 
• This lack of sensation lasts anywhere between 45 minutes to 240 minutes, depending on the drug.
• During this period, the patient is awake and has control of his breathing as well as his hands. 

More often than not, we tend to give drugs to let the patient sleep through the procedure even after a spinal. Occasionally however, we do get patients who want to stay awake and are not afraid of the sounds of the operation theater. 

That is when you may have scenarios like the one in the picture above. Some of the memories that come to mind for me from my own personal experiences with patients undergoing surgery under spinal anesthesia -

• I have written years ago about the girl who took my mobile and defeated all my high scores in Fruit Ninja even as surgeons cheered her on as they fixed her leg!
• I have given ball-by-ball updates to patients during IPL cricket matches.
• I have given my phone to a young lad who called up his mother waiting anxiously outside the operation theater to let her know he is fine and there is no need to worry.
• I have received advice on insurance policies from a patient (picture that in your head - a salesman trying to make me buy a health insurance policy from him while his appendix is being removed.)
• I have sat with so many patients and watched live with them on the television screen as the urologist searched for, crushed and removed their kidney stones. (For those who play computer games, it looks like a first-person-shooter set in a very wet planet.)

I am limiting this to just spinal anaesthesia but the truth is, depending on the type of anaesthesia given, you can literally play cards with me with your left hand while surgeons operate on your right hand. That is how amazingly precise Modern Anaesthesia is.

All these things I am telling you are in fact, decades and even centuries old (the first spinal was given 119 years ago!) And yet, spinal anaesthesia is still absolutely magical when you really think about it.

• I am inserting a single needle blindly into your back. 
• With no gadgets at my disposal, I am evading your vertebral bones and avoiding your spinal cord, seeking out a space deep within that I cannot see. 
• And when I find it, I will give the drug in a volume less than a teaspoon inside that space. And with that amount (less than 4 ml), I can remove your appendix, fix your hernia, take out your kidney stones or fix your fractured hips and YOU WOULD NOT FEEL A THING.
• A volume less than half a teaspoon (2ml) is enough and you will be wide awake and absolutely pain-free as your baby is delivered by Caeserean section.

For 22 centuries (600 BC to 1846 AD), surgeons operated without anaesthesia as patients howled, begged for mercy and even died of the surgical pain. It is just over 17 decades since the luxury of anaesthesia reached mankind.

In 1848, 15 year old Hannah Greener died on the operating table after walking in to get a toenail removed, the first documented death due to anaesthesia. Today in 2017, 15 year old children are laughing and playing games on their mobiles while surgeons fix their broken legs.

That is how far we have evolved over those 17 decades. Yes, there are still so many risks we face as anaesthesiologists even today with complicated cases but the vigilance of knowing what can occur and the knowledge of how to treat them help save the day in hundreds of operation theaters around the world.

There is so much more to spinal anaesthesia - the eligibility criteria, pros and cons, how it relates to your vital parameters etc. The fact is that spinal anaesthesia is an art form where theoretical knowledge weds practical skill. In the end, your anaesthesiologist always remains the best judge of the appropriate mode of anaesthesia for your surgery.

Got some doubts or an experience to share? Type them in the comment section below.

Want to know more about anaesthesia?

I have written articles on:

1. The Magical Origins of Anaesthesia (Featured in Huffington Post)

2. Can you really be pain-free and play games while undergoing surgery? Why, yes.

3. Poll: Tell me About Your Experience Under Anaesthesia

4. How Anaesthesia Defeated Religious Beliefs to Change the World for Women

5. What I learned watching anaesthesiologists with differing views treat patients

6. What we can learn from Dr Horace Wells' untimely failure

Public Awareness About Anaesthesia: 

What is General Anaesthesia?
What are the Various Types of Anaesthesia?

10 Things Your Anaesthesiologist asks You at Your First Meeting

Misconceptions About Spinal Anaesthesia
Facts About Labour Analgesia