Before you go to sleep
If you haven’t already met your anaesthetist you will meet them either on the ward or in the anaesthetic bay on the day of your surgery. At this stage if you have any concerns or worries about your operation or anaesthetic please let them know.
Once in the anaesthetic bay you will have an intravenous drip placed and often you will be given a sedative “relaxing medication” just before going into the operating theatre. You often will not remember much after being given the sedative. Once inside the operating theatre you will have several monitors placed (these monitor things like your blood pressure, heart rate and breathing patterns). Once these are placed you will be given an oxygen mask and then receive another injection through the drip. Depending on the type and extent of the surgery you may either have a full general anaesthetic or local anaesthetic with sedation.
LOCAL ANAESTHETIC WITH SEDATION
If the area of surgery can be covered completely with local anaesthetic, we can often perform the surgery with local anaesthesia with the assistance of sedation. Injecting local anaesthetic can be quite painful (especially if you are injecting over a large area), however once injected the area anaesthetised will feel no pain. To assist with the pain of injection we frequently give you a short-acting anaesthetic agent during injection, that way you feel and remember no pain. After the local anaesthetic is injected we allow the sedation to wear off. Frequently this will not occur till the end of the operation and many of our patients remember nothing of the whole procedure and for all intents and purposes they fell as if they have had a general anaesthetic. What are the advantages ?
- You generally wake up feeling more ”awake”.
- You generally will be fit to eat and drink earlier than with a general anaesthetic.
- You will generally be fit for discharge earlier.
- There is less chance that you will have post operative nausea and vomiting.
- Possibly less chance of post operative confusion in the elderly.
- Occasionally we will choose this option in a patient with many medical problems that your surgeon and anaesthetist feel make a general anaesthetic very unsafe.
Note that your surgeon and anaesthetist work very closely together to provide you with the best service possible, if they are not comfortable that they can perform the operation with local anaesthetic and sedation they will not offer it to you.
Whether you have a full general anaesthetic or sedation your anaesthetist will remain with you monitoring your operation, anaesthetic and all your vital physiological functions. They stay with you until you reach the recovery room where your care will continued by the recovery staff. While you are in recovery if you have any discomfort or feel nauseous or sick it is important that you let the recovery staff know. They can administer pain-killers or anti-nausea drugs if they are required. The aim is to have you comfortable when you leave recovery for the ward.
YOUR STAY IN HOSPITAL
Depending on the type of operation you may stay over-night or go home.The local anaesthetic combination that we have devised generally gives very good pain relief for up to 24 hours, so generally if you need to stay in hospital overnight you are comfortable from a pain point of view. We will generally give you paracetamol regularly during your stay and frequently you will need no further pain relief, however if you have any pain or problems please let your nursing staff know as you will have stronger pain killers available.
Whether or not you are going home on the day of surgery or the next day you need someone to pick you up from the hospital and take you home. If you go home on the day of surgery it is also advisable to have someone at home with you that first night after surgery. With practice over the last 4 years we feel we have a great local anaesthetic combination that will give you good pain relief for the first day after surgery . If you have a general anaesthetic you will still have local anaesthetic injected at the end of your operation for pain relief. We generally recommend most of our patients take regular paracetamol for 2-3 days after their surgery. If the paracetamol is taken regularly we often find our patients do not require any other pain relief. You will be given a prescription for some stronger pain killers just in case you need them.