OpenHealth Q&A

General Anesthesia for Removal of a Lipoma in the Lower Back

A 30-year-old male, standing 5’10” and weighing 225 pounds, presents with no significant health concerns. He has endured persistent back pain since the age of 15, which he has managed intermittently through physical therapy. While the therapy offers temporary relief, it fails to address the underlying issue. Common advice he receives includes strengthening his core and increasing flexibility. Coinciding with the onset of his back discomfort, he also became aware of a lipoma located on his lower back. Throughout his life, he was assured that such growths were not associated with back pain. Now at 30, after beginning a career in nursing, he recognizes that his back pain is unusual and warrants further examination. Initially, at age 15, he underwent X-rays focused on his lumbar and sacroiliac areas, both of which yielded normal results. His perspective shifted upon reading about individuals experiencing similar pain linked to their lipomas. Seeking clarity, he consulted his brother, a third-year radiology resident, who confirmed that lipomas could indeed be a source of discomfort. The nature of his pain is localized to the right side of his lower back, approximately 1.5 to 2 inches from the spine, near the area commonly referred to as the dimples of Venus. He describes the sensation as a constant ache that does not radiate into his legs, and there is no accompanying numbness or tingling. The discomfort manifests as significant stiffness and soreness, particularly noticeable in the morning, exacerbated by prolonged sitting or walking. This side feels perpetually tense and unstable. Following an X-ray of the sacroiliac joint that also returned negative results, an ultrasound was conducted to verify the presence of the lipoma, which measured 1.4 x 1.2 x 2.2 cm. Based on the findings, the radiologist suggested surgical intervention, which led him to request a consultation with a surgeon. He anticipated being informed that the lipoma was unlikely the source of his pain. Upon entering the examination room, the surgeon mentioned he had heard about the lumps on his back. After examining the area, he swiftly agreed to proceed with the removal, surprising the patient. The surgeon, who had considerable experience, asserted that while this phenomenon typically isn’t documented in textbooks, he had encountered numerous cases where removing lipomas relieved patients of chronic low back pain with unremarkable imaging results. He informed the patient that general anesthesia would be utilized during the procedure, which would last approximately two hours from the beginning of IV administration until waking up. However, the patient expressed concern as his brother, who tends to prioritize textbook guidelines, had previously stated that general anesthesia would generally not be used. Initially dismissing the idea when the patient mentioned his girlfriend's mother’s understanding of the procedure, the brother was taken aback when updated on the surgical consultation outcomes and the anticipated duration. The discussion also covered potential reasons for the length of the procedure, including the need for thorough removal due to the possibility of the lipoma fragmenting, with some methods involving cauterization. Emphasizing that the planned sedation is true general anesthesia rather than twilight sedation, the patient, as a nurse, acknowledges that while using general anesthesia isn’t the preferred route, it remains a safe option. He questions the typicality of employing general anesthesia for lipoma excision on the back and considers whether remaining conscious during the procedure is preferable, particularly as the lipoma is not visible without palpation. The surgeon may have valid concerns regarding patient movement during the operation. Moreover, the brother didn’t feel an MRI was necessary, given the absence of nerve-related symptoms, positing that severe arthritis would manifest on an X-ray. The patient voiced worries about conditions like ankylosing spondylitis due to morning stiffness, but was reassured that any such significant changes would be evident on an X-ray, noting that his posture appeared unaffected. He remains convinced that the lipoma is the cause of his issues, particularly since the pain feels as though it emanates from it, and it has not changed in size over the past 15 years.

Answers (1)

7/13/2025, 7:10:46 PM

OpenHealth AI

It's understandable to have concerns regarding the use of general anesthesia for your lipoma removal, particularly given its implications and your background in nursing. Here’s a breakdown of the key points and guidance for your situation.

Key Points

1. Lipoma and Pain Connection: While lipomas are generally considered benign and often not associated with pain, your personal experience and the surgeon's insights suggest a potential link in your case.
2. General Anesthesia Considerations: General anesthesia can be warranted, especially if the surgical procedure requires the patient to be completely still. This is particularly crucial for surgery on the back, where movement can complicate the process.
3. Your Symptoms: Your ongoing back pain, stiffness, and the location of the lipoma near the painful area makes the situation unique, warranting further attention.

Explanation

Lipomas can sometimes contribute to discomfort depending on their size and location, especially if they are pressing on nerves or surrounding structures. Although it's true that many lipoma removals are performed under local anesthesia, if deeper tissues are involved or if patient movement is a concern, general anesthesia may be a safer choice for both you and the medical team.

Next Steps

1. Clarify Anesthesia Options: Consider discussing the anesthesia plan in further detail with your surgeon. Ask about the possibility and implications of regional or local anesthesia options, especially since you have hesitations regarding general anesthesia.

2. Express Concerns: Clearly communicate your worries about general anesthesia to your surgeon. They can explain the rationale based on their experience and may even assure you of safety protocols in place to minimize risks.

3. Monitor Symptoms: While you await the procedure, keep a detailed record of your symptoms, including any changes in pain levels, stiffness, or relationships to activities. This will help you discuss any observations with your healthcare provider later.

4. Pre-Surgery Preparations: Ensure you follow any pre-operative instructions regarding fasting or medication adjustments. If you are anxious, explore relaxation techniques to help manage stress leading up to your surgery.

5. Post-Procedure Follow-Up: After the surgery, keep an eye on your recovery and follow any post-operative care recommendations closely. This includes managing pain and monitoring for any signs of infection at the surgical site.

Remember, it's essential to feel comfortable with your care plan, so ensure your questions and concerns are addressed prior to the surgery. Your proactive approach will help in achieving the relief you're seeking.