General anesthesia is the typical anesthesia one normally associates with major surgical procedures. It is employed generally as a combination of medications and usually includes gas which is breathed in under pressure through a mask or is introduced into the lungs by means of an endotracheal tube. Sometimes the anesthetic agent is injected IV or even IM, but more commonly it is gas. General anesthesia is capable of taking the patient into 3 planes or levels of anesthesia, depending on the type of procedure and the depth of anesthesia required. The object of this type of anesthesia is to produce total analgesia (obliteration of pain sensation) and amnesia (lack of remembrance). An interesting peculiarity regarding general anesthesia is that the patient senses no passage of time as one would when sleeping and awakening. Thus a patient taken to surgery and given general anesthesia feels that he has "gone under" and awakened in an instant, no matter how long the procedure. General anesthesia is administered and monitored by either a MD anesthesiologist or a Nurse Anesthetist who has specialized training in anesthesia and is supervised by the anesthesiologist.
General anesthesia has attendant with it some amount of risk, though most untoward episodes can be handled without problems by a competent staff. Although it is done, I would not feel comfortable having general anesthesia anywhere but in a hospital or a well equipped surgi-center, as if a rare severe problems occurs, time, expertise and the proper equipment is of the essence. Following general anesthesia a patient is transferred to a recovery room, now termed PACU (Post Anesthetic Care Unit) in many facilities, where the patient is brought out of anesthesia and monitored for problems by specialty nursing staffers under the direction of an anesthesiologist. The patient typically remains in the recovery room for a couple of hours or so, and then is either discharged to home if the procedure is out-patient or return to his/her hospital room if in-patient.
General anesthesia is never really necessary for most foot surgeries, but some patients still request it out of fear of knowing what's going on during the procedure.
Regional Anesthesia is anesthesia in which a "local" anesthetic agent is inject about a nerve at a site remote from the surgical site to effect a nerve block of the sensory nerves serving that operative site. Spinal and epidural nerve blocks are typically what is employed, but actually any block that is not at the specific site of the surgery (called an infiltration block) could be termed regional anesthesia. Both regional and infiltration blocks are well employed in foot surgery. Pure regional and infiltration anesthesia do not employ sedation.
MAC anesthesia (Monitored Anesthetic Care) is regional or even infiltration anesthesia coupled with some form of sedation (usually administer IV)which causes the patien to drift in and out of sleep and feel a lack of aprehension about what is transpiring. The patient is monitored by an anesthesiologist or nurse anesthesiologist.
Although, in the early days of my career, I employed general anesthesia, as I was hospital trained and that was pretty standard at the time, as the years went on I went to MAC anesthesia and finally local infiltration or low regional nerve block. In my view, it has become impractical to employ spinal anesthesia as just about all foot procedures are out-patient and although it's been shown to likely have nothing to do with it, patients not kept on their backs after spinal anesthesia will often complain of headaches, and I don't need that headache even if it has nothing to do with it.
As far as recurrences, certainly the deformity that results in a bunion is one of functional imbalance in the foot, and I suppose that it is possible that the same imbalance that caused the initial problem could cause it again. But, in fact, I have not seen that happen, although I can't be certain that patients that I operated 10-15 years ago and had a recurrence would not go somewhere else and I might never know. As any honest surgeon will admit, I have had failures and recurrences, but I attributes these to inadequate correction from the get go.
How much post-operative disability and how long it lasts is dependent upon a number of facts, not the least of which is the patien. But I would suggest that it will be a good number of weeks before you would be able to walk 3 miles four times a week. Post-surgically you will experience varying degrees of swelling, which is part of the healing process as repairative tissues are brought to the surgical site. Along with it you will experience some level of discomfort which varies from patient to patient and you will have some degree of disability, which, again, varies from patient to patient. The vast majority of my surgical patients tell me that they had experienced less pain and less disability than what they had expected, but I am generally rather conservative in my promises to patient. I would rather lose the patient than promise them something that I can't deliver. Patients need to understand that surgery is controlled trauma and in spite of the best wishes of all, patients heal when they heal. I've often advise patients not to have surgery if they believe something terrible will happen in their life if they are not fully recovered in x number of days or weeks.
Hopefully, this will give you some insight in what you are in for. The vast number of bunionectomies in my hands have been successful and if you have chosen your surgeon carefully, I suspect that you will be pleased.
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