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.

The viral photo where a patient is happily playing mobile games while doctors operate on his leg thanks to spinal anaesthesia

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.
Spinal anaesthesia

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.


shalz75 said…
This made for a very interesting and amazing read- thanks for sharing such pertinent info via an amusing incident!!
Carol Graham said…
Never thought about it -- what a great idea. It would take your mind off of what was going on - for sure
Never thought I'd say this but you actually made that doc stuff interesting!
Alana said…
When is this coming to a hospital near me?
The expertise ,experience and dedication needed for such a dedicated procedure is beyond scope of normal iagination.An excellent read.I wish I had my mobile phoine with me during Csection!
I am stunned and speechless!
Awesome write up!! Reminded me of the one time that I had to lend my phone to a patient and he got a taste of the rock music on it!!! In the end he was like "Yo doc!! That was an amazing experience!!"

Prasanna from Team Mocktailmommies
Soumya said…
Quite a read this is. Something like this deserves to go viral I'd say :D

I would love to be awake if I'm being operated upon. Also, I hope that a day would not come when I'd have to be operated upon.
Rachna said…
Wow, doc. It was lovely reading it. Of course, I experienced it when I gave birth to my elder son. I was wide awake and talking to my husband while the doctor performed the C-section.
Menaka Bharathi said…
I still remember when i gave birth to my daughter my doctor kept on talking with me and i was unconsciously awake where she was telling me every step...It was just a fraction of second that i dint realize the pain.
Shalini said…
C section, Mobile phone and Spinal anesthesia! I'm game- whenever it is :P But, thanks for sharing this important information.
Boopathy said…
Well written as usual and precise to the point Roshan
That is quite amazing! Love how you've detailed the entire procedure and given us practical ways to understand the concept too. I bet you're still fuming at the defeat at the girl's hands ;)
I received spinal anesthesia during the C-section but could never think of playing mobile games during the operation. The historical dates and the different cases were interesting to read.
Damn, Doc! You're like the anaesthetic God. Okay, God of Anaesthesia :P
Thanks for the detailed run down - never actually stopped to think about the science of all this. But really? You let a patient beat your scores? Did she give you a duffin?
tulika singh said…
I remember seeing this on Facebook and wondering how, how on earth is it possible. It seems not only is it possible but also pretty common. And it's silly of me to not know this considering I received it during my C-section. I don't seem to remember much though, it was all so surreal.
Shirley Corder said…
What a fascinating article! I knew of the spinal anaesthesia, in fact had it for a total knee replacement, but I was put to sleep for the entire procedure. Thanks for sharing. Share Your World with Vetkoek and curried bunnies.
sathwika said…
That’s a nice one.
rajlakshmi said…
wowww this is so fascinating... We indeed have come such a long in medical field. It's amazing to see a patient play games on phone while doctors are performing a surgery. Bewildering! Thanks for sharing this post :D
glad you enjoyed it :) wanted to present it differently.
yes... that is part of the plan. Usually though, we encourage them to sleep
tough to do but somebody's gotta do it :)
Pretty sure it is already here since decades :)
haha.. wanted to showcase the possibilities.
Spinal anaesthesia has been around for centuries actually.
haha... great to hear that. We anaesthetists tend to be the DJs too occasionally
yes... here's wishing you never have that experience :)
exactly... C-section is a perfect example.
modern variations include labour analgesia where the mother can deliver the child while totally awake and feeling no pain.
haha.. remember this post when the time comes :)
revenge will be mine!!!!!
showcases how far we have moved on in anaesthesia...
don't remind me... the memory still haunts. I get recurring nightmares!
haha... patients being awake during surgeries done under spinal or regional blocks is quite common. We can opt to help them sleep or else they may ask to remain awake and idle the time away.
TKR can get boring for the patient, awake in that position for hours.
Happy to showcase what anaesthesia is all about and how far we have come :)
tulika singh said…
Remember this one and how amazing it is. Thank goodness for science, or I might not even have had the twins.
Your posts are always interesting. I am a fan of your writing. Thanks for sharing.

Hiral Amodia said…
I went through a spinal 2.5 months back and it was all fine. However I definitely cant play a video game while I was getting operated for a fractured leg. I loved your post and all the cases that you have mentioned in it.
RICHA said…
This was a good read, what hell lot of experiences you have shared seem hilarious and courageous too!!! IPL score is ecpi!!!
No doubt spinal anaesthesia comes a long way in making medical procedure easy and safe. That's hilarious a patient undergoing Operation is selling Health insurance you.
A very useful read,some of the points can be remembered and shared with others.
I loved reading this. I had an epidural which is a form of spinal anaesthesia. You are right its about the skill of the anaesthesist that matters. I still cannot imagine how the patient had his work mode on and tried selling you insurance.
Deepa said…
Wow! This is something new. Very interesting indeed. We surely have come a long way. Medical science and it's advancements are superb.
شركة نقل عفش بالرياض وجدة والدمام والخبر والجبيل اولقطيف والاحساء والرياض وجدة ومكة المدينة المنورة والخرج والطائف وخميس مشيط وبجدة افضل شركة نقل عفش بجدة نعرضها مجموعة الفا لنقل العفش بمكة والخرج والقصيم والطائف وتبوك وخميس مشيط ونجران وجيزان وبريدة والمدينة المنورة وينبع افضل شركات نقل الاثاث بالجبيل والطائف وخميس مشيط وبريدة وعنيزو وابها ونجران المدينة وينبع تبوك والقصيم الخرج حفر الباطن والظهران
شركة نقل عفش بجدة
شركة نقل عفش بالمدينة المنورة
شركة نقل اثاث بالرياض
شركة نقل عفش بالدمام
شركة نقل عفش بالطائف
vishal bheeroo said…
True we have come a long way and the idea would freak me out for serious operations, preferring sleep though was awake during my lipoma surgery Quite an experience for my first adult surgery. I like the human approach you have as a doctor with patients to bring comfort in such harrowing times.