Information about Your Anaesthetic and Pain Control After Surgery Information for patients Specialist Support If you require this leaflet in another language, large print or another format, please contact the Health Information Centre Tel: (023) 9228 6757, who will advise you.
Preparing yourself for surgery If you smoke, giving up or cutting down can reduce the risk of breathing problems. If you have loose teeth or loose crowns, you should see your dentist to reduce the risk of damage to your teeth during your anaesthetic. Any long-standing medical problem such as diabetes, asthma or high blood pressure, should be checked by your GP, if you have not been recently. Before coming into hospital Before your surgery you will usually see a nurse at a preassessment clinic, or be called at home to discuss your:- Health and any medical problems, any allergies/sensitivities, regular medicines - including herbal remedies. and to decide if you require any tests eg blood taking or heart tracing (ECG). You will also be given instructions about taking your normal medicines; you can normally continue to take them as usual on the morning of your operation unless told not to do so. You should ask questions about what to expect. On the day of your operation Fasting The hospital should give you clear instructions about the latest time you are allowed to eat and drink before your operation. It is important to follow these. If you have food or drink in your stomach during your anaesthetic it is possible to vomit and cause damage to the lungs. 2
Illness If you feel unwell when you are due to come into hospital, please contact the ward for advice. It may be safer to cancel your surgery and wait until you are fully fit. Occasionally we can only decide you are not well enough to go ahead, once you have come in and been examined. The Anaesthetist Anaesthetists are fully qualified doctors with specialist training. They are responsible for giving your anaesthetic and for your wellbeing and safety throughout your surgery. You will meet your anaesthetist before your operation. They will ask you questions about your health, previous anaesthetics and usual medicines. They may need to examine your chest with a stethoscope and examine your neck and mouth. They will explain the anaesthetic to you and what pain relief is suitable so you can discuss the options. Please ask questions and tell them of any worries you may have. Types of Anaesthesia General Anaesthesia (GA) This is a combination of medicines, which are given to make you unconscious (asleep), so you do not feel anything and will not be aware of what is going on around you during the operation. These are usually given through a very small tube (cannula) placed in your hand or arm by the anaesthetist. During surgery the anaesthetist often also gives you anaesthetic vapours to breath. Local Anaesthetics (LA) These are medicines that have a numbing effect, to stop you feeling pain, but do not cause any loss of consciousness. Local anaesthetic injections can be used alone to numb a small area of the body such as a finger. 3
Local anaesthetic blocks/spinals and epidurals are used for operations on larger or deeper parts of the body such as your arm or tummy. The types of anaesthetic are often combined for example an epidural may be given as well as a general anaesthetic, to provide pain relief after the operation. Sedation This is normally given to you through a drip in your hand or arm, or sometimes as a gas to breathe in. This is to make you feel relaxed, calmer and a little drowsy, but awake enough to talk. There will be a member of staff that will communicate with you and a monitor will be attached to watch your heart rate and blood pressure. The sedation medicines affect your memory for the time you are being given them and some people do not remember anything about their procedure. Benefits and Risks of Anaesthesia Serious problems are uncommon in modern anaesthesia and many complex and life saving procedures can be carried out with a high degree of comfort and safety. It is difficult to separate the risks of the anaesthetic from the risks of the operation and your general health. The risks to you as an individual will depend on: Whether you have any other illnesses Personal factors, such as whether you smoke or are overweight Surgery that is complicated, long or done in an emergency. 4
Information about your anaesthetic Although people react differently to medication, some side effects are quite common with anaesthetics, such as Feeling or being sick Damage to lips or tongue (usually minor) and a sore throat. Confusion, memory loss, dizziness, blurred vision, headaches. Bladder problems, backache, aches and pains. Itching, bruising and soreness. Uncommon side effects include Chest infection Muscle pains Slow breathing (depressed respiration) Damage to teeth An existing medical condition getting worse Awareness (becoming conscious during your operation) Rare or very rare complications include Equipment failure Damage to eyes Serious allergy (reaction) to drugs Heart attack or stroke Nerve damage Deaths caused by anaesthesia are very rare. There are probably about five deaths for every million anaesthetics given in the UK. Pain relief options 1. Oral medicines (taken by mouth) in the form of liquids or tablets. 2. Intravenous (IV) medication given straight into your vein. 5
6 3. Patient Controlled Analgesia (PCA) these are pumps with morphine type drugs that will go straight into your blood stream (vein) and are controlled by you. If you feel sore you press the button, which is connected to a pump that gives you a dose of painkiller. The PCA is a safe form of pain relief because the pump will prevent you from giving yourself too much. Occasionally the painkiller causes sickness, drowsiness and itching, but these side effects can be treated. 4. Suppositories are small tablets that either you or a nurse will place up your bottom. They work quickly and can be very effective if you are not able to take medicines by mouth. 5. Injections either into your thigh, buttock or arm we do not often use this route. 6. Local anaesthetic infusions eg Rectus Sheath Infusion for tummy operations. These are small plastic tubes that are placed under the skin, near the wound during surgery. The tubes deliver numbing medicine to the wound and help with pain relief after your operation. This is a very safe form of pain relief, with a small risk of infection and bruising. The tubes are usually removed 2 to 3 days after your operation. 7. Spinals and Epidural infusions are similar injections of a local anaesthetic between the bones in your back, to temporarily numb the nerves to the lower body. A spinal will wear off over 12-24 hours, whereas the epidural involves inserting a very fine plastic tube, through which the local anaesthetic is given continually by a pump. It can be used for several days after surgery to reduce your pain, allow deep breathing/coughing, help you to move more comfortably and aid your recovery. An Epidural is a safe and effective form of pain relief, but complications can occur, such as a headache, low blood pressure and heavy legs.
Serious complications including infection and nerve damage are rare. Long lasting nerve damage with on-going numbness or weakness is very rare indeed, affecting about 1 in 10,000 patients. Your anaesthetist will explain and discuss this in more detail and the pain team will aim to review you on the ward. The Recovery Room This is where you will wake up after your operation, near the operating theatres. Specialist nurses will look after you until you are comfortable and ready to return to the ward. You will be given painkillers if you need them and treatment for any nausea or sickness. Anxiety will make any pain feel worse, so it is important that you express any worries and ask any questions you may have. How is pain measured? In Portsmouth Hospitals NHS Trust, we ask our patients to describe the level of pain being felt by using a simple scale 0 = No pain 1 = Mild pain 2 = Moderate pain 3 = Severe pain Your scores are then recorded and can hep the doctors and nurses work out the best pain relief method for you. In this hospital, an Acute Pain nursing team and anaesthetists, work alongside the doctors and nurses on the ward to monitor your pain control and aim to visit all the surgical wards each day. The more information you have the better you will be able to cope with the pain. You are the only one who knows how much it hurts! It is important to let the nurses and doctors know when the painkillers are wearing off and you feel uncomfortable. Do not wait until your pain is unbearable. This is important because having less pain will allow you to move around better and this will help you recover quicker. 7
Finding out more Some of the text used in this leaflet is extracted from the Royal College of Anaesthetists patient information leaflets Anaesthesia explained and You and your anaesthetic. The Royal College of Anaesthetists and The Association of Anaesthetists have produced a number of useful information leaflets about anaesthesia, which can be accessed via the Internet at www.youranaesthetic.info. Information we hold about you and your rights under the Data Protection Act Please refer to the booklet Your Healthcare Information Your Rights! Our Responsibilities! for further guidance. How to comment on your treatment We aim to provide the best possible service and staff will be happy to answer your questions. However, if you have any concerns you can also contact the Patient Experience Service on 0800 917 6039 or E-mail: portsmouthhospitals.patientexperience@porthosp.nhs.uk Consent What does this mean? Before any doctor, nurse or therapist examines or treats you they must have your consent or permission. Consent ranges from allowing a doctor to take your blood pressure (rolling up your sleeve and presenting your arm is implied consent) to signing a form saying you agree to the treatment or operation. It is important before giving permission that you understand what you are agreeing to. If you do not understand ask. Author: Acute Pain Nurse and + Consultant Anaethetist Reference: Ana/11 Date: Sept 2014 Review date: Oct 2016 Medical Illustration ref: 14/4785 Portsmouth Hospitals NHS Trust Previously Information about your anaesthetic (07/1089) and Pain and its control following surgery (12/1921).