This is going to hurt. Which is why whatever it is (most often surgery) is preceded by painkillers of some sort. At least, most of the time. In this trope, something means the character chooses to go through the experience with no anesthesia.
This can be used to indicate that the patient is a badass, that the situation is dire, or both. Alternately, this can show that the patient Feels No Pain. (If no one knows he doesn't feel pain, he could be going for some cheap badass points.)
Another variation of this trope is when a character wishes to use an alternative to modern anesthesia. Hypnosis and acupuncture, among other methods, have been used to block pain in Real Life.
This can be Truth in Television. Modern general anesthesia both paralyzes the patient (to hold him still) and blocks pain, there are proven cases where the mix was off and only the first effect occurred. Someone performing Self-Surgery will be limited to local anesthetics at best, and in a Life-or-Limb Decision situation there may not be any painkillers available.
While to be fair, this should be limited to eras/universes where anesthesia is available in the first place, this doesn't limit us by much. The sap of the opium poppy was used by the Minoan civilization, and that's not the only herbal painkiller out there. The painkilling effects of ethanol would also have been known for at least as long.
Can happen as part of Meatgrinder Surgery, but not always.
- Gunslinger Girl. Hilshire is wounded carrying out an assassination mission he should have assigned to his cyborg Triela. When Triela discovers this, she flees in tears as she's been conditioned to protect his life at all costs. Hilshire tracks her down and they return to their hotel room, where Triela has to remove the bullet using a pocket knife and no anesthetic, because Hilshire is worried she'll try running away again. Hilshire passes out anyway from the pain and Triela does decide to walk out on him, but barely makes it out the door before having a Love Epiphany.
- In Higurashi: When They Cry, the villain's Evil Plan requires vivisecting one of the protagonists. Still, the villain is courteous enough to note that although the victim needs to be alive while their entrails are being pulled out, they don't need to be conscious for this, and offers them a general anesthetic. In the one arc where the victim remembers their previous lives in the "Groundhog Day" Loop, they refuse the anesthetic, hoping that this will burn the villain's face into their memory, so their next incarnation has more time to stop the bad guys (it doesn't really work, however).
- In the "Dingos" episode of the Black Jack manga (later adapted as episode 28 of the anime series, "Wilderness Epidemic"), Black Jack performs Self-Surgery to excise parasites and infected tissue while he's being stalked by a pack of dingoes. Due to the situation, he could do no more than local anesthesia.
- The Authority: In one issue, The Midnighter had surgery and remained awake for the whole time to ensure the people performing the surgery didn't do anything stupid like kill him at the villain's request (since he's also the one making the surgeons remove the bomb he had implanted in the Midnighter's chest). As an extra precaution, the villain's six-year-old self is being held in the Midnighter's arm, ready to cause a paradox at the first hint of trouble.
- Inverted in the Warhammer 40,000 comic Damnation Crusade — a tech-priest says it will be easier to repair a Dreadnought if the occupant remains awake, his superior wants the occupant sedated first. The occupant agrees with the tech-priest and tells them to get on with it, mildly affronted at the suggestion that a little pain will bother him.
- The first issue of Invincible Universe sees Robot commissioned to perform surgery on a dying supervillain who also happens to be the host/jailer for a monstrous dragon. In order to keep the dragon from escaping, he is instructed to forgo anesthesia.
- In Justice League of America: Superpower, as Antaeus' body becomes increasingly cybernetic, he tells the doctors to just skip the anesthesia.
- Bullet Points: The procedure to install the command device for the Iron Man armor requires both the patient to be awake and to be installed in the heart. Steve Rogers accepts.
- In Doctor Strange: The Oath. Strange is able to endure a chest operation without anesthesia by projecting his spirit from his body. Naturally, he can't resist commenting on the surgeon's technique while floating nearby.
- The Bourne Legacy has Aaron remove a Tracking Device in his hip once he realized he was being targeted as part of The Purge. This is done swiftly out in the Alaskan wilderness and it looked quite painful. It was later established that the "chems" Aaron and the other operatives take are designed to either delude or help them to ignore pain.
- In Little Shop of Horrors, Orin, the sadistic dentist, only uses laughing gas for himself.
- Subverted in The Martian. Mark Watney gives himself local anesthetics, but removes the piece of his biomonitor before they take effect.
- Tank Girl. Kesslee has lost his arm and suffered severe damage to his face. His doctor offers him a shot to make him comfortable.
Kesslee: No painkillers. Do I make myself clear, Doctor?
- Played for Laughs in Jerry Lewis's Cracking Up (aka Smorgasbord: The Movie). Dr. Grassnover Perks (played by Lewis), a sort of Buddhist monk, has a ruptured spleen and needs surgery. On the operating table, he tells the surgeons "No anesthetic," and explains that he will put himself into a deep trance where he will feel no pain. The doctors are incredulous, but ultimately agree. Dr. Perks invokes a silly-sounding Magical Incantation, lies back, and says "You may begin." Of course, the whole thing is subverted when, as soon as the lead surgeon makes the first cut, Perks yells "Ouch! That HURTS!!", and runs around the operating room yowling with pain.
- In the film adaptation of Master and Commander: The Far Side of the World by Universal Studios, young Lord Blakeney takes severe damage to his right arm during the first skirmish between the French ship Acheron and the British Surprise. This injury necessitates amputation, done while Lord Blakeney is conscious and aware, no anesthetic at all. The patient can only bite upon a wooden rod wrapped with leather while the ship's surgeon saws through his humerus.
- In Sin City: A Dame to Kill For, Johnny goes to a Back-Alley Doctor to remove the bullet from his leg and fix his broken fingers, he isn't given anesthetic.
- Supplemental material for the Revenge of the Sith film has Darth Sidious transform Anakin Skywalker into Darth Vader without any anesthetic so that the sheer pain of the surgery can fuel his Dark Side powers.
- In the first book of the Sword of Truth series, Kahlan is given some leaves to chew while she is having her wound treated. Upon learning it's an anesthetic, she spits the leaves out - the nature of her powers makes any loss of control too risky.
- In Tom Clancy's The Cardinal of the Kremlin, the state trooper who was shot refuses pain medications to stay conscious and inform his superiors about his shooters and the hostage in the backseat.
- In The Stars My Destination, after Gully and Jisbella escape from prison, they go to a Back-Alley Doctor to have his Embarrassing Tattoo bleached from his face so that he's less recognizable by the authorities. Since the two have just had a nasty argument, she puts up money for the procedure but not the anesthetic. Eventually though, she can't stand his pain and gives in and pays the extra money.
- In Ender's Shadow, the villainous Achilles is granted surgery to fix his lame leg. Achilles has a pathological need to always appear strong, so he insists that the doctor not give him anesthetic, but she refuses. So for putting him out so she could mend his leg, Achilles kills her.
- Happens in Rocket Boys when Sonny cuts his wrist open on some scrap metal and almost bleeds to death. At first he accepts the doctor's offer to give him a shot before the stitches, until he's told that his father didn't take any after being hurt in the mine. Sonny instantly changes his mind once the needle goes in and screams "Deaden it! Deaden it!" but the doctor cheerfully says that it's too late.
- Lensman: Played with in Gray Lensman. Kinnison has barely survived torture and needs radical surgery. He offers to just keep his mental nerve block up, but the doctors convince him that he needs to be out cold due to possible psychological trauma from what they'll have to do to him. Then the anesthesia only blocks the pain and leaves Kinnison conscious. Worsel has to be brought into the operating room to put Kinnison under via mental powers.
- In Derek Robinson's WW2 air epic Piece of Cake, Squadron-Leader Rex refuses anesthetic because he feels he cannot be spared from the air war over France. He does not want to be sidelined with a woozy head and unfit to fly. The medical officer then sighs and tells him to hold on tight, as he removes a lot of German shrapnel from Rex's back and buttock muscle. Far from taking time out to recover, Rex then goes back in the air having demanded a stimulant drug to keep him awake and alert.
- In Cheaper by the Dozen, Dad decides to have his tonsils out with only a local anesthetic to show the children that they're being wimps. He winds up coming home in bad shape.
- The Greater Good: When Cain is faced with cutting off his own leg to escape a Tyranid spore's grasp, Jurgen offers to get a local analgesic out of his first aid kit. Cain would love to take one, but he doesn't think he has time to spare. (He was probably right, though since the Reclaimers chose that moment to arrive on the scene it was a moot point.)
- It's hard to find in English, but there's a Gabriel García Márquez story in which this is played for drama. The mayor of a small town comes to see the town dentist with an abscessed molar. The dentist makes up a bogus reason why he can't put him under anesthesia, but really it's to make him suffer for being part of the military junta that killed some of the townspeople.
"Now you're paying us back for those twenty dead men, Lieutenant."
- In Stargate Atlantis, when they first met Ronon he revealed he had a tracking chip at the base of his brain stem that the Wraith used to track him down for sport. As he didn't trust the others, he insisted Dr. Beckett perform fairly intense surgery with him awake, sitting up and holding his gun. Subverts the norm as he passed out from the pain once the chip was removed.
- An episode of Burn Notice had Michael with a bullet in the back from an assassin trying to kill him. It was from a ricochet and wasn't deep but still hurt like hell. As he didn't want to have to explain it to a hospital he had his brother fish it out, and the narration brings up that he had to deal with third world medicine before.
- The Flash (2014): Barry's Super Speed also increases his metabolism to the point that if he did use anesthetic it would burn right through him before finishing any kind of surgery.
- Game of Thrones, "Kissed by Fire": as Qyburn prepares to operate on Jaime Lannister's amputated stump, he offers Milk of the Poppy to dull his pain, but Jaime turns him down. When it's pointed out that "there will be pain, Jaime simply says "I'll scream" - and when Qyburn rephrases it to "quite a bit of pain", Jaime replies "I'll scream loudly". In this case, Jaime doesn't trust the man working on him - justifiably so - and wants to remain undrugged to keep an eye on the situation.
- Dollhouse. Adelle DeWitt at the end of "A Spy in the House of Love" when she's getting a gunshot wound stitched up by Dr Saunders. It's implied she's punishing herself for trusting Laurence Dominic, who turned out to be an NSA mole.
- Col. Flagg of the CID insists on going into surgery without anesthetic because if he's knocked out he might inadvertently talk, and nobody at the unit is cleared to hear any of the state secrets he might accidentally divulge.
- In another episode a Turk and a Greek soldier are both at the 4077th at the same time trying to out-stoic one another, refusing anesthetic after a fight at Rosie's bar.
Turkish soldier: What's this?BJ: Something to kill the pain while I fix your leg.Turkish Soldier: I am Turk. I not need that.Greek Soldier: If Turk no need, Greek no need.Charles: Heh. That'll teach him a lesson, boy.
- In one episode of Scrubs Turk is asked to perform surgery on a patient that is under hypnosis. Turk is reluctant, but eventually does it.
- Doctor Who: In "The Gunfighters", the Doctor passes up the offer of anesthetic from Doc Holliday when having his tooth pulled. Of course, his options were a slug of whiskey or a rap on the noggin with a pistol.
- NYPD Blue: Andy, who is a recovering alcoholic, has prostate cancer. When they try to do a CAT scan on him he has a possible heart attack due to a reaction to the dye they inject him with and they take him to the ER. He is given morphine for the pain. He rejects it at first but is convinced that it's necessary in this case. Later, after he has surgery to remove his prostate, Andy is given a button to dose himself with painkillers. He keeps it "in reserve" again due to his addiction.
- Bonanza: In "Second Chance", Little Joe is shot with an arrow and the arrowhead needs to be cut out. When the doc offers him some booze before the operation, Little Joe declines the offer: "I don't need anything like that." He passes out during the procedure, but it still comes across very manly.
- In one episode of Nip/Tuck, Christian's nose is broken by his latest paramour, requiring surgery to fix it, but is concerned that his partner Sean might botch the surgery. Christian requests that the doctors only give him topical anesthesia so that he can talk Sean through the procedure.
- In the Tim & Eric's Bedtime Stories episode "Tornado", Father Krang's punishment for Matt Peters' excessive discharge is castration. Krang sees it fair to have the procedure performed while Matt is fully conscious. Learning this prompts Matt to emit a Stock Scream as the operators get started.
- In an episode of Without a Trace, two agents have tracked a criminal to a local clinic (he was shot during a melee). They find him holding a doctor hostage and forcing her to treat his wound. When they question the doctor after he manages to escape again, she mentions that he refused any painkillers, suspecting that she was trying to knock him out so that she could call the police.
- Subverted in one Garfield strip where Jon is talking about his uncle, "Tough Bob", who once had surgery without anesthetic. After that, everyone called him "Screaming Bob".
Garfield: He sure has big eyes.
- According to Bill Cosby, attempted by his wife, who studied natural childbirth and practiced breathing and everything, despite labor pain being described as "grab your bottom lip and pull it over your head". Subverted, however, when the first contraction hit.
Cosby: My wife stood up—in the stirrups—grabbed my bottom lip, and shouted, "I WANT MORPHINE!"
- Played for laughs in Team Fortress 2's Meet the Medic vid. The Medic is trying out an experimental new surgery on The Heavy, while keeping him alive and awake using the medigun.
Heavy: Should I be awake for this?Medic: Well... no. But as long as you are, could you hold your ribcage open a bit?
- In Mass Effect 3, a video log in Cerberus's HQ reveals that The Illusive Man is undergoing some kind of surgical procedure to give him reaper-esque "upgrades" and he specifically requests "no anaesthetics."
- Cyborgs in Metal Gear Rising: Revengeance have their pain receptors turned off in combat, but when Raiden acts as Jack the Ripper, he forces them back on because he likes the pain.
- Metal Gear Solid V: Ground Zeroes: After saving Chico and Paz from Camp Omega, Big Boss discovers stitches on Paz's belly and quickly realizes that she was implanted with a bomb. The medic that accompanied him has no choice but to open her up to remove said bomb without anesthetic, since they don't know when the bomb will go off. It's not pretty.
- Forced upon Warren in The Surge, where upon being strapped to the operating table to be surgically fitted with a shiny new exoskeleton, the surgery bot says "Patient sedated". He wasn't.
- In Telltale's The Walking Dead games, characters rarely have access to painkillers whenever they need surgery given how the series takes place during a Zombie Apocalypse where any kind of medical supplies are a luxury. Each season has a scene of a character being forced to endure surgery without anaesthesia: Lee getting his arm amputated in Season 1 Episode 5 (though this one can be opted out of), Clementine suturing her arm in Season 2 Episode 1, extracting the bullet from Samantha and cauterizing the wound in Michonne Episode 2, again, pulling a bullet out from Kate in A New Frontier, and removing shotgun pellets from A.J. in The Final Season. Expect lots of screaming and blood in most of these scenes, which truly show how much of a Crapsack World the games take place in.
- Star Wars: The Old Republic: Part of the Imperial Agent storyline on Nar Shaddaa involves Cipher Nine having implants installed alongside their spine so they can infiltrate a terrorist meeting holographically disguised as a utility droid. The player can opt to have this done without anesthesia due to not trusting the surgeon, an ex-Imperial Intelligence "Watcher" incarcerated at a Black Site. Cut to a brief shot of Cipher Nine lying on their side screaming in pain as Watcher X obeys their wishes.
- In The Salvation War, Memnon refuses to be put to sleep when the surgeons are amputating his ruined wings so he can grow new ones, because a mighty demon such as himself fears no pain. The medics agree and then cheerfully drug him anyway.
- From Things Mr. Welch Is No Longer Allowed to Do in an RPG:
2224: Anesthetic is not just for sissies.
- In Twig, the Duke of Francis' uncle attempts to invoke this trope during his physical enhancement surgery as a child, explaining that the pain is the price to become effectively invincible and immortal. This comes as a surprise to the surgeons, who had in fact already administered anesthetic due to not expecting to be ordered to torture a member of the royal family.
- In Transformers: Prime Megatron stole the arm of the deceased Prime Liege Maximo and had it replace his own arm. When Knock-Out prepared to induce stasis (as Cybertronians feel pain like any other organism) Megatron refused, claiming he wanted to bask in the power he was about to receive. That and, given the track record of Decepticons to try and go for a Klingon Promotion, he probably didn't want to risk someone taking a chance at him while he was out.
- Referenced by Cotton Hill in King of the Hill in the story of how he and Deedee met. While at a VA hospital, Cotton tells the patient next to him:
I don't take no anesthetic. Did Lincoln ask for girly gas when they blow'd his head off?
- Towards the end of the SpongeBob SquarePants episode, "For Here or to Go", Plankton actually succeeds in getting a krabby patty thanks to the Bogus Business Bureau, however, Mr. Krabs forces him to swallow it in the Krusty Krab, which the BBB allows. After Plankton swallows it, he runs back to the Chum Bucket as fast as he can and orders Karen to perform surgery on him right away to get it out of his stomach. Karen asks Plankton if she should apply anesthetic first, but Plankton tells her there isn't time for that, as they have to get the patty out before it's digested. Even with the anesthetic skip, the krabby patty is already half-digested, much to the horror of the customers who tried to order krabby patties from the Chum Bucket.
- In the season 5 finale of The Venture Bros., Dr. Mrs. The Monarch is treating Dr. Venture's injuries from the previous episode, including a dislocated joint she takes off his pants and prepares an anesthetic for. However, when Rusty suggests that she make it into a Happy Ending Massage, an unamused Sheila tosses out the anesthetic and just sets the joint by hand, much to Rusty's agony.
- During the Napoleonic Wars, a lot of amputations were conducted without anesthetic even though both alcohol and opium were available. Part of the reason was that it was considered unmanly.
- Advocates of natural childbirth prefer to use breathing exercises, massage, and hypnosis to manage labor pains, instead of painkilling drugs.
- According to at least one biographer, Adolf Hitler absolutely refused anesthesia because of a fear of losing control - that whoever ran Germany while the Fuhrer was under might like it so much he'd refuse to give the Reich back. He underwent complex dental treatment without sedation. His dentist remarked that the pain must have been excruciating, but Hitler withstood it without flinching.
- It is sometimes advisable to ask a dentist to not use anesthetic for a minor treatment, as the tooth nerves are only affected if the holes in your tooth are very deep, and the numb feeling inside your mouth is rather unpleasant. Sometimes avoiding the bit of pain you do feel even when the drill doesn't hit the nerve, is just not worth it.
- This man had to under go major heart surgery without any painkillers. The short of it is that he had a cancerous growth wrapped around his heart, and literally any general anesthetic they could use would relax the heart. Which was already fighting as hard as it could to pump. That being said, no general anesthetic doesn't mean no pain management, they had a specialist in the operating room solely to help him with the pain, and they pumped with as much local anesthetic as they could.
- Some people fear needles so much that the pain of the other procedure is preferable to getting an injection of local anesthetic. Such folks also usually prefer having gas given for surgery prep before the IV is inserted.