Anaesthesiology, Intensive Care and Pain Medicine

There are many types of anaesthesia. The type of anaesthesia you may have depends on your medical condition and the type of surgery. Your anaesthetist will advise you on the appropriate type of anaesthesia after discussion with you and the surgical team.

Anaesthesia

In a general anaesthetic, a mixture of drugs is given to keep you unconscious and pain free during the operation. Drugs are injected into the blood stream via a vein or breathed in as gases or vapours into the lungs.

A device may be placed in your throat or windpipe to help you breathe when you are asleep. The device is removed when you wake up after surgery.

Regional

Regional anaesthesia involves injecting local anaesthetics to numb the region to be operated. No pain is felt during surgery although it is possible you may feel pressure or movements.

Common types of regional anaesthesia include spinal and epidural anaesthesia where a needle is inserted between the bones of the spine to inject a small amount of local anaesthetic in the space or fluid surrounding the spinal cord. These techniques can also be used for postoperative pain relief.

Other parts of the body such as the arm can also be safely anaesthetised by injecting local anaesthetics into the appropriate region. The effect of the local anaesthetic is temporary. You may also be given drugs to make you feel relaxed and drowsy during the procedure.

Local

Local anaesthesia refers to temporarily numbing the area to be operated on by injecting local anaesthetic into the skin. This is usually performed for minor procedures such as stitching of cuts.

Monitored Anaesthetic Care (MAC) Local anaesthesia is injected by the surgeon to numb the operative area and mild sedation is provided for by the anesthetist.

​The benefits of regional anaesthesia include excellent pain relief after surgery, less nausea and vomiting and early return to drinking and eating after surgery.

Headache is an infrequent complication of spinal or epidural anaesthesia. It is usually temporary but may be severe and last several days.

Nerve damage due to infection, bleeding or other causes is a rare complication. This may cause weakness and numbness of the body part that the nerve supplies.

​Before the operation you and your anaesthetist can decide whether you remain fully awake during the operation or prefer to be sedated so that you are not so aware of the whole process. The amount of sedation can be adjusted so that you are aware but not anxious. Local or regional anaesthesia may be combined with general anaesthesia.

All anaesthesia has some risks and these depend on many factors such as co-existing medical conditions and the type of surgery. Anaesthesia risks can be thought of in terms of side effects and complications.

Side effects are sometimes unavoidable but generally temporary. Complications are unexpected and unwanted effects due to a treatment and can be serious.

Common Temporary Side Effects:

• Nausea and vomiting
• Sore throat
• Pain or bruising at injection sites
• Dizziness
• Blurred vision
• Shivering
• Infrequent Complications
• Muscle pains
• Headaches
• Allergic reactions
• Temporary breathing difficulties
• Damage to teeth, dental prosthesis
• Damage to voice box which may cause temporary loss of voice
• Damage to nerves and pressures areas
• Chest infection
• An existing medical condition getting worse e.g. stroke, heart attack
• Extremely Rare and Serious Complications
• Severe allergic reactions
• Permanent nerve damage
• Damage to eyes
• Awareness under general anaesthesia
• Brain damage

Yes. Your anaesthetist will assess your preference and advise you on the most appropriate choice of anaesthesia. It is usually possible to accommodate individual patients' wishes.

Anaesthesia is very safe. There are some risks and possible complications. Most complications can be prevented. Good communication is important. Make sure you inform your doctor of all your medical conditions, medications, allergies and previous anaesthetic experience.

It is important that you follow the instructions to help you prepare for surgery such as medications to take or to avoid and how long to fast (NO FOOD OR DRINK) before surgery.

Very minimal, if at all. It depends on:

• Your personal pain threshold
  Some patients have higher thresholds and feel less pain. You can let your anaesthetist know of your personal pain threshold based on your previous experience with injuries or operations.
• Type of operation
  This will not only affect how much pain you feel, but also how long you feel the pain. Your anaesthetist will speak to you regarding pain management options for your operation before your surgery.

Your nurses and doctors will assess the amount of pain you are feeling in a few standardized ways:

• By asking you to grade your pain on a scale of 0 - 10, with 0 representing no pain and 10 representing the worst pain you have ever felt. If you find this to be very difficult, they may also ask you to grade your pain according to whether it is mild, moderate, or severe.
• By looking at your heart rate, blood pressure, and breathing rate.
• By observing how well you are able to take deep breaths, cough, and move around. This may include asking you to move the affected body part, sit up in bed, or even walk around. your nurses and doctors are trained to assist you during this assessment so as to minimize the amount of pain or discomfort that you feel

It varies with the option chosen. Our costs are very competitive and include not just the equipment and the the medication used, but also the visits that our nurse and anaesthetist will make after your operation to ensure your pain is well managed. Your anaesthetist will be more than happy to discuss the cost of various techniques.

Most patients want to avoid pain if possible, and we want to treat it as well as we can.

Untreated acute pain often leads to anxiety, insomnia, and sometimes even a total loss of function. Research also shows that pain has many other less obvious undesirable consequences, such as increasing the risk of irregular heartbeat, heart attack, breathing difficulty, poor intestinal movement, decreased immunity, and an excessive tendency for blood to clot. All these may lead to complications, increased hospital stay, and even death.

All patients will receive painkillers before and throughout the operation. Post-operative pain management options are:

• Swallowed painkillers like panadol
• Non steroidal anti-inflammatory drugs (NSAIDs) such as brufen, ponstan, synflex, voltaren, arcoxia, or celebrex
• Opioids such as tramadol and oxycodone. Side effects are rare, and the benefits of decreased pain far outweigh the side effects of painkillers.

Side Effects

• Panadol - drug allergy, liver impairment, and kidney impairment
• NSAIDs - drug allergy, aggravation of asthma, gastritis, liver impairment, and kidney impairment.
• Opioids - drowsiness, nausea, vomiting, constipation, and itching.
• Injected painkillers like opioids such as tramadol, fentanyl, morphine, or oxycodone, and an injectable type ofNSAIDcalled toradol.

Patient controlled analgesia (PCA)

A pump containing an opioid is connected to your iv cannula. This delivers a fixed dose of medication when pressed. It allows you to control the amount of painkiller you receive, and therefore control the amount of pain you feel. There is a lockout built in so you cannot overdose yourself.

Spinal

A very fine needle is inserted into the spinal canal. Local anaesthetic is injected through the needle and acts on the spinal nerves to produce loss of pain sensation and strength in the lower half of the body. Usually used for operations on the lower half of the body. Side effects are uncommon and include headache, bleeding at the injection site, and nerve injury. The risk of paralysis is extremely rare.

Epidural

A needle is inserted into the epidural space just around the spinal canal. Local anaesthetic may be injected through the needle, or a thin tube may be placed in the space, after which local anaesthetic is injected through it. The epidural works in almost the same way as the spinal. Side effects are also similar to those for the spinal option.

Nerve block

A needle is inserted into the space around the nerve that supplies the part of the body to be operated on; can be the arm, the leg, or even the abdomen. Ultrasound guidance is often used to ensure that the needle is in the right location. Nerve stimulation may also be used to confirm that the needle is in the right location. You may feel painless twitches of your muscles during the nerve stimulation. Local anaesthetic is injected through the needle and acts on the nerve to produce loss of pain sensation and strength in the affected body part. Side effects are uncommon and include bleeding at the injection site, injury to surrounding structures, and nerve injury. The risk of paralysis (like the spinal option) is extremely rare.

Besides tablets, swallowed painkillers also come in liquid form, which may be easier for you.

What if I don't like injections?

A plastic tube called an iv cannula is usually painlessly inserted into your hand before the operation. most injected painkillers are then given through this cannula with minimal discomfort.

Pain management options like the spinal, epidural, and nerve block usually require an additional injection before the operation, for safety reasons. your anaesthetist will usually give you painkillers and medication to help you relax before the additional injection is performed.

Panadol? I can get it over the counter and cheap! Why do I have to take it after an operation?

Panadol is widely available and cheap. However, research also shows that it is an effective painkiller when taken in combination with other stronger painkillers. In our experience, we find that prescribing panadol together with other stronger painkillers is often very effective in treating mild to moderate pain often reducing the amount of stronger medication needed.

You are probably being treated for moderate to severe pain. Research has shown that painkillers are more effective and have less side effects when combined with other painkillers

Though opioids can be addictive, there is no evidence that using opioids to treat acute pain leads to addiction. You will be reviewed frequently by your doctors if you are on opioids, and the opioids will be stopped when you no longer require them. There is therefore minimal risk of addiction.

Please inform your anaesthetist of the above. Your experience may be due to a particular opioid, in which case a different opioid may be substituted with satisfactory results. or a repeat of your bad experience may be avoided by prescribing prophylactic (preventive) medication together with the opioid.

As can be seen above, there are many pain management options available. It is extremely rare that a patient is allergic to all the painkillers that we have available.

You will be reviewed regularly by your surgeon, by the pain nurse and anaesthetist. They will assess whether your symptoms are due to the painkillers and advise you accordingly.

The risk of complications from your chosen pain management option is usually very low. Even so, you will be reviewed regularly by your pain nurse and anaesthetist. In the unlikely event that complications occur, your pain nurse and anaesthetist will give you the best possible treatment to minimize your chance of a permanent injury.

It is likely that if you stop taking the medications you will start feeling pain. Most patients would rather not feel any pain at all, than to feel pain before starting painkillers. Besides, they also work to reduce inflammation and swelling, contributing to a faster recovery from surgery.

It is very rare that the pain management option you have chosen does not work. If it does not, your anaesthetist will work extra hard to ensure that you suffer minimal pain and discomfort and that the cause of failure is addressed and/ or a new alternative is offered

You will be seen daily by the Acute Pain Service team. They will ensure that your pain continues to be well managed and that any side effects or complications are picked up and addressed in a timely manner.

There is 24 hour ward coverage provided by the anaesthetist on duty. Your nurse or doctor knows when to refer issues regarding your pain management option to the anaesthetist on duty.

In some instances, acute pain may become chronic pain. It is important, then, to find out the source of the pain, and why it is lasting for so long. Your doctor will contact the anaesthetist on duty for advice and everything will be done to minimize the pain and suffering you have to endure.