Anaesthetics Leaflets

The leaflet is detailed below, or you can download the 'Epidurals in Labour' leaflet in PDF. 

Setting Up Your Epidural

You will need to have an intravenous cannula and a drip.

While the epidural is being put in, it is important that you keep still and let the anaesthetist know if you are having a contraction.

Usually takes 20 minutes to set up and 20 minutes to work.

Some epidurals do not work fully and need to be adjusted or replaced.

Advantages of an Epidural

• Usually provides excellent pain relief.
• Sometimes a spinal is given first for a quicker effect.
• The dose or type of local anaesthetic can sometimes be altered to allow you to move around the bed. This is a low-dose (or mobile) epidural.
• In general epidurals do not affect your baby.
• Can be topped up for caesarean section if required.

Possible Problems with Your Epidural

• Repeated top-ups with stronger local anaesthetic may cause temporary leg weakness and increase the risk of forceps or ventouse delivery.
• The epidural may slow down the second stage of labour slightly.
• You may develop low blood pressure, itching or a fever during the epidural.
• The epidural site may be tender but usually only for a few days.
• Backache is NOT caused by epidurals but is common after any pregnancy.

Risks of Having an Epidural to Reduce Labour Pain

Type Of Risk	How Often Does This Happen?	How Common Is It?
Significant drop in blood pressure	One in every 50 women	Occasional
Not working well enough to reduce labour pain so you need to use other ways of lessening pain	One in every 8 women	Common
Multiple Attempts   Procedure may be performed by a different Anaesthetist to the one performing the pre-operative assessment	Unknown	Occasional
Not working well enough for a Caesarian section so you need to have a general anaesthetic	One in every 20 women	Sometimes
Severe headache	One in every 100 women	Uncommon
Nerve damage (e.g. numb patch on a leg or foot, or having a weak leg). Effects lasting for more than 6 months	Temporary – One in every 1,000 women   Permanent – One in every 13,000 women	Rare   Please note most nerve damage in pregnancy is related to the birthing process, e.g. obstetric palsy
High block	One in every 2,000 women	Rare
Epidural Abscess (infection)	One in every 50,000 women	Very rare
Meningitis	One in every 100,000 women	Very rare
Epidural Haematoma (Bloodclot)	One in every 170,000 women	Very rare
Accidental Unconsciousness	One in every 100,000 women	Very rare
Severe Injury, including being paralysed	One in every 250,000 women	Extremely rare

 

 

 

 

 

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download 'General Anaesthesia for Caesarean Section (CS)' leaflet in PDF. 

This card is to give you some information about being put to sleep with a general anaesthesia.

• A general anaesthetic is often needed for an emergency Caesarean section if there is not enough time to put in a spinal anaesthetic or an epidural. It may also be an option for those who would prefer it. This can be discussed with your Anaesthetist.
• You will have a needle called an intravenous cannula placed in your hand or arm.
• One risk of a general anaesthetic is that the acid in your stomach can pass into your lungs when you are asleep. To reduce this risk, you may be given an injection through a drip or into your leg, and you may be given antacid medicine to drink.
• In the operating theatre a mask will be placed over your face for you to breathe oxygen through. The mask may feel tight, but it is important to give you extra oxygen.
• The general anaesthetic will be given into your drip. As you fall asleep, you will feel pressure on your neck. This is to protect your airway and lungs.
• Your birth partner will not be able to be with you to the operating theatre, but they will be nearby.
• You will wake up in the recovery room and can see your baby as soon as you are awake.
• When you wake up, your throat may feel sore, and you may feel sick. More painkillers and anti-sickness medication will be available if you need them.

In the UK each year, 17,000 general anaesthetics are given to women who are having a

Caesarean section, and there are few complications. However, there are some risks and side effects of general anaesthetics. These are shown below.

 

Risks and Side Effects of General Anaesthesia
Possible Problem	How Common the Problem is
Shivering	Common - about 1 in 3 people
Sore throat	Common - about 1 in 3 people
Feeling Sick	Common - about 1 in 3 people
Muscle Pain	Common - about 1 in 3 people
Cuts or bruises to lips and tongue   Damage to teeth	Occasional – about 1 in 20 people   Quite rare – about 1 in 4,500 people
The anaesthetist failing to insert a breathing tube when you are asleep   Chest Infection   Acid from your stomach going into your lungs	Uncommon – about 1 in 250 people   Common – about 1 in 10 people – but most infections are not severe   Quite rare – about 1 in 1,000 people
Being awake during the procedure	Uncommon – about 1 in 400 people
Severe allergic reaction	Rare – about 1 in 10,000 people
Death   Brain damage	Very rare – fewer than 1 in 100,000 (1 or 2 people a year in the UK) Very rare – exact figures are not known

Accurate figures are not available for all these risks and side effects. Figures are estimates and may vary from hospital to hospital. If you have any questions, you should discuss these with your Anaesthetist.

Data adapted from Obstetric Anaesthetists’ Association. For more information please visit:

http://www.LabourPains.com

 

The leaflet is detailed below, or you can download 'Regional Anaesthesia for Caesarean Section (CS)' leaflet in PDF. 

Regional anaesthesia (an epidural or spinal anaesthetic) is a type of pain relief where you have an injection of local anaesthetic in your lower back to completely numb you from the chest down. Your legs will also become numb, and you will not be able to move them. It usually takes between 10 and 20 minutes for the anaesthetic to take full effect.

Setting up The Anaesthetic

• You will first have a drip attached through a needle called an intravenous cannula placed in your hand or arm.
• An anaesthetist will inject local anaesthetic into your lower back.
• You will have a tube called a catheter inserted to empty your bladder.
• Your blood pressure and oxygen levels will be checked frequently.

Your birth partner may be allowed to be with you during this procedure, please check with your Anaesthetist.

Advantages of a Regional Anaesthesia

This is the commonest form of Anaesthetic for women who need a Caesarean Section. It allows you to be awake for the birth of your baby and the pain relief after regional anaesthetic is usually more effective than after a general anaesthetic.

Possible Problems with a Regional Anaesthesia

• The anaesthetic doctor will check to make sure that you are numb before the operation is started. These checks are not 100% reliable and you may experience unpleasant feelings during the operation.
• It is common to feel pulling and pushing inside your tummy, and you should not be alarmed. Sometimes there may be mild pain which can be treated by giving you a painkiller in the drip or to breathe in through a mask or mouthpiece. Occasionally you may feel severe pain. If this happens, the anaesthetist will probably give you a general anaesthetic very quickly. This will put you to sleep.
• It is common for the anaesthetic to cause your blood pressure to drop. This may make you feel sick or faint. Your anaesthetist will give you medicine to treat this as soon as it happens. Sometimes the medicine is given before you have these symptoms.

Accurate figures are not available for all of these risks and side effects. Figures are estimates and may vary from hospital to hospital.

This information is a summary and is adapted from the Obstetric Anaesthetists’ Association website.                  

More information can be found on this website at Labour Pains - Information on pain relief choices during labour

If you have any concerns, please discuss them with your anaesthetist.

 

Risk and Side Effects of Regional Anaesthesia
Possible Problem	How Common the Problem is
Itching	Common – about 1 in 3 to 10 people, depending on the drug and dose
Significant drop in blood pressure	Spinal: Common – about 1 in 5   Epidural: Occasional – about 1 in 50
Epidural given during labour not effective enough to be topped up so another anaesthetic is needed for the Caesarean section   Anaesthetic not working well enough and more drugs are needed to help with pain during the operation   Regional anaesthetic not working well enough for Caesarean section and general anaesthetic is needed	Common – about 1 in 8 to 10       Spinal: Occasional – about 1 in 20 Epidural: Common – about 1 in 7     Spinal: Occasional – about 1 in 50 Epidural: Occasional – about 1 in 20
Multiple attempts at spinal/epidural   Procedure may be performed by a different Anaesthetist to the one performing the preoperative assessment	Occasional
Severe Headache	Epidural: Uncommon – about 1 in 100 Spinal: Uncommon – about 1 in 500
Nerve Damage (For example, numb patch on a leg or foot, weakness of a leg)   Please note that most cases of nerve damage occur due to the birthing process, such as an obstetric palsy	Effects lasting less than six months: Quite Rare – about 1 in 1,000 to 2,000   Effects lasting more than six months: Rare – about 1 in 24,000
Meningitis	Very rare – about 1 in 100,000
Abscess (infection) in the spine at the site of the spinal or epidural   Haematoma (Blood clot) in the spine at the site of the spinal or epidural   Abscess or haematoma causing severe injury, including paralysis (paraplegia)	Very rare – about 1 in 50,000     Very rare – about 1 in 168,000     Very rare – about 1 in 100,000
A large amount of local anaesthetic being accidentally injected in a vein in the spine   High block- A large amount of local anaesthetic being accidentally injected into spinal fluid, which may cause:   difficulty in breathing unconsciousness	Very rare – about 1 in 100,000             Quite rare – about 1 in 2,000 Very rare – about 1 in 100,000

 

 

 

 

 

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the 'Anaesthesia - BMI' leaflet in PDF. 

Below are a few important points, about how a high BMI changes what we do in labour.

Having an Anaesthetic

• Most of our tasks are made more technically difficult for you and for us, by a high BMI
• However, aiming for a more normal weight, by diet and exercise, makes things easier!
• If you need an operation, a spinal anaesthetic has advantages over going to sleep (general anaesthetic) - in most patients

Pain Relief with Epidurals

• If you would like an epidural, its best to ask for one early on
• If it works well, it can be used for any operation afterwards, avoiding a general anaesthetic
• If your BMI is very high, it may not be possible to put one in—so please keep an open mind about other pain relief options

Taking blood, putting in drips, spinals and epidurals can be more difficult in women with a high BMI. It may take us and the midwives more time, so please be patient.

We are happy to answer any questions when you come to see us in the Clinic

Write them down to help you remember.

 

 

 

 

 

 

 

 

The leaflet is detailed below, or you can download the 'You and your Anaesthetic' leaflet in PDF.

Information to help patients prepare for an anaesthetic

This leaflet gives information to help you prepare for your anaesthetic. It has been written by patients, patient representatives and anaesthetists, working together.

You can find more information leaflets on the website www.rcoa.ac.uk/patientinfo. The leaflets may also be available from the anaesthetic department or pre- assessment clinic in your hospital.

The website includes the following:

• Anaesthesia explained (a more detailed booklet)
• Your anaesthetic for major surgery
• Your spinal anaesthetic
• Epidural pain relief after surgery

Risks associated with your anaesthetic

Below are specific risks associated with having an anaesthetic or an anaesthetic procedure. It supplements information available on the website: www.rcoa.ac.uk/patientsinfo

Side effects and complications

 

Regional Anaesthetic (RA)

General Anaesthetic (GA)

More information on the side effects and complications than is listed here

can be found on the website (www.rcoa.ac.uk/patientinfo

RA      =         This may occur with a regional anaesthetic

GA      =         This may occur with a general anaesthetic

Very common and common side effects

RA GA          =         Feeling sick and vomiting after surgery

GA                =         Sore throat

RA GA          =         Dizziness, blurred vision

RA GA          =         Headache

RA GA          =         Bladder problems

GA                =         Damage to the lips or tongue (usually minor)

RA GA          =         Itching

RA GA          =         Aches, pains and backache. Pain during injection of drugs. Bruising                   and soreness where a needle was inserted in order to give fluids or medication (usually after the tube/cannula is removed).

GA                =         Confusion or memory loss

Uncommon side effects and complications

GA                =         Chest infection

GA                =         Muscle pains

RA GA          =         Slow breathing (depressed respiration)

GA                =         Damage to teeth

RA GA          =         An existing medical condition getting worse

GA                =         Awareness (becoming conscious during your operation) - This is more likely to occur during a sedation technique where the aim is to allow the procedure to be performed with the best recovery profile.

Rare or very rare complications

GA                =         Damage to the eyes. Heart attack or stroke.  Serious allergy to drugs. Nerve damage

RA GA          =         Death

RA GA          =         Equipment failure

Deaths caused by anaesthesia are very rare. There are probably about five deaths for every million anaesthetics in the UK.

Understanding risk

In modern anaesthesia, serious problems are uncommon.

Risk cannot be removed completely, but modern equipment, training and drugs have made it a much safer procedure in recent years.

To understand a risk, you must know:

• how likely it is to happen
• how serious it could be
• how it can be treated.

The risk to you as an individual will depend on:

• whether you have any other illness
• personal factors, such as smoking or being overweight
• surgery that is complicated, long or done in an emergency.

More information about risks associated with having an anaesthetic can be found on www.rcoa.ac.uk/patientinfo

What is anaesthesia?

Anaesthesia stops you feeling pain and other sensations.

It can be given in various ways and does not always make you unconscious.

Local anaesthesia involves injections that numb a small part of your body. You stay conscious but free from pain.

Regional anaesthesia involves injections that numb a larger or deeper part of the body. You stay conscious but free from pain.

General anaesthesia gives a state of controlled unconsciousness. It is essential for some operations. You are unconscious and feel nothing.

Anaesthetists

Anaesthetists are doctors with specialist training who:

• discuss the type or types of anaesthetic that are suitable for your operation. If there are choices available, your anaesthetist will help you choose what is best for you
• discuss the risks of anaesthesia with you
• agree a plan with you for your anaesthetic and pain control
• are responsible for giving your anaesthetic and for your wellbeing and safety throughout your surgery
• manage any blood transfusions you may need
• plan your care, if needed, in the intensive care unit
• make your experience as calm and pain free as possible.

The pre-assessment clinic

If you are having a planned operation (rather than emergency) you will usually be invited to a pre-assessment clinic a few weeks or days before your surgery.

Staff at the clinic will assess your general health. You will be asked questions and a nurse or doctor may listen to your heart and lungs. Tests will be organised if necessary. This will often include blood tests and an ECG (heart tracing).

You are likely to be checked for certain important infections – usually by using a swab on your skin, or in your nose.

The staff will want to make an accurate list of the medicines you take. Please bring a list or the medicines themselves in their boxes.

If you are allergic to anything, this will be written down.

If necessary, arrangements may be made for you to see an anaesthetist.

If you may need a blood transfusion during or after your operation, a blood test will be needed to prepare for this. You can ask for information about the risks and benefits of blood transfusion. Blood transfusions are generally avoided unless necessary.

If you know you have high blood pressure, it is a good idea to bring a list of any recent blood pressure readings. This is because blood pressure can rise in a hospital clinic, and this may not be a true picture of your usual blood pressure.

More information

This is a very useful opportunity for you to ask any questions that you have about the anaesthetic and about coming into hospital generally. If the staff do not have all the answers you need, they will be able to help you find out more.

Pain relief afterwards

Good pain relief is important, and some people need more pain relief than others. It is much easier to relieve pain if it is dealt with before it gets bad. Pain relief can be increased, given more often, or given in different combinations.

Occasionally, pain is a warning sign that all is not well; therefore, you should always report it to your nurses and seek their advice and help.

Here are some ways of giving pain relief:

Pills, tablets or liquids to swallow

These are used for all types of pain. They take at least half an hour to work. You need to be able to eat, drink and not feel sick, for these drugs to work.

Injections

These are often needed and may be intravenous (through your cannula into a vein for a quicker effect) or intramuscular (into your leg or buttock muscle using a needle, taking about 20 minutes to work).

Suppositories

These waxy pellets are put in your rectum (back passage). The pellet dissolves and the drug passes into the body. They are useful if you cannot swallow or if you might vomit.

Patient-controlled analgesia (PCA)

A machine allows you to control your pain relief yourself. The medicine enters your body through your cannula. If you would like more information, ask for a leaflet on PCA.

Local anaesthetics and regional blocks

These types of anaesthesia can be very useful for relieving pain after surgery. More details can be found in the leaflet Epidural pain relief after surgery (www.rcoa.ac.uk/patientinfo

Local and regional anaesthetics

If you are having a local or regional anaesthetic:

• your anaesthetist will ask you to keep quite still while the injections are given. You may notice a warm tingling feeling as the anaesthetic begins to take effect
• your operation will only go ahead when you and your anaesthetist are sure that the area is numb
• you will remain alert and aware of your surroundings, unless you are having sedation. A screen shields the operating site, so you will not see the operation unless you want to
• if you are having sedation, you will be sleepy and relaxed. However, you may be aware of events around you
• for regional anaesthetics, your anaesthetist is always near to you and you can speak to him or her whenever you want to. For local anaesthetics, other theatre staff may be looking after you.

General anaesthetics

There are two ways of starting a general anaesthetic:

• anaesthetic drugs may be injected into a vein through the cannula. This is generally used for adults
• you can breathe anaesthetic gases and oxygen through a mask, which you may hold if you prefer.

Once you are unconscious, an anaesthetist stays with you at all times and continues to give you drugs to keep you anaesthetised.

The Recovery room: After the operation, you will usually be taken to the recovery room. Recovery staff will make sure you are as comfortable and free of nausea as possible. When they are satisfied that you have recovered safely from your anaesthetic you will be taken back to the ward.

Before coming to hospital

•  If you smoke, giving up for several weeks before the operation will reduce the risk of breathing problems during your anaesthetic, making your anaesthetic safer.
• If you are very overweight, reducing your weight will reduce many of the risks of having an anaesthetic.
• If you have loose teeth or crowns, treatment from your dentist may reduce the risk of damage to your teeth during the anaesthetic.
• If you have a long-standing medical problem such as diabetes, asthma or bronchitis, thyroid problems, heart problems or high blood pressure, you should ask your GP if you need a check-up.

On the day of your operation

Nothing to eat or drink – (‘nil by mouth’)

The hospital should give you clear instructions about eating and drinking. These instructions are important. If there is food or liquid in your stomach during your anaesthetic, it could come up into your throat and damage your lungs.

If you are a smoker, you should not smoke on the day of your operation.

If you are taking medicines: most medicines should be continued before an operation, but there are some important exceptions. You will need specific instructions from the pre-assessment team about your tablets.

If you feel unwell when you are due to come into hospital, please telephone the ward for advice.

Meeting your anaesthetist

Your anaesthetist will meet you before your operation. They will refer to the discussion you had in the pre-assessment clinic. They will discuss the anaesthetic you could have, including benefits, risks and your preferences. They will then:

• decide with you which anaesthetic would be best for you
• decide for you, if you would prefer that.

If there is a choice of anaesthetic, this will depend on:

• the operation you are having and your physical condition
• your preferences and the reasons for them
• the recommendation of the anaesthetist, based on experience
• the equipment, staff and resources at the hospital.

Pre-medication (a ‘pre-med’) is given before some anaesthetics. Pre-meds prepare your body for surgery – they may start off the pain relief, reduce acid in the stomach or help you relax. Some pre-meds make you more drowsy after the operation. If you think a pre-med would help you, please ask your anaesthetist.

A needle is used to start most anaesthetics in adults. If you are very worried about this, please talk to your anaesthetist.

Sedation. This is the use of small amounts of anaesthetic or similar drugs to produce a ‘sleep like’ state. If you are having a local or regional anaesthetic, you will need to decide whether you would prefer to:

• be fully alert
• be relaxed and sleepy (sedation) but not unconscious
• have a general anaesthetic as well.

Nothing will happen to you until you understand and agree with what has been planned. You have the right to refuse if you do not want the treatment suggested or if you want more information or more time to decide.

When you are called for your operation

•  A member of staff will go with you to the theatre.
• You can wear your glasses, hearing aids and dentures until you are in the anaesthetic room. You may be able to keep them on if you are having a local or regional anaesthetic.
• Jewellery and/or any decorative piercing should ideally be removed.
• If you cannot remove it, the nurses will cover it with tape to prevent damage to it or to your skin.
• If you are having a local or regional anaesthetic, you can take your own electronic device, with headphones to listen to music.
• You may walk to theatre, accompanied by a member of staff, or you may go in a wheelchair or on a bed or trolley. If you are walking, you can wear your own dressing gown and slippers.
• Final checks will be done as you arrive in the operating department, before the anaesthetic starts. You will be asked to confirm your name, the operation you are having, whether left or right side (if applicable), when you last ate or drank and your allergies. These routine checks are normal in all hospitals.

Starting the anaesthetic

Your anaesthetic may start in the anaesthetic room or in the operating theatre. Your anaesthetist will be working with a trained assistant. The anaesthetist or the assistant will attach machines that measure your heart rate, blood pressure and oxygen levels.

Almost all anaesthetics, including some kinds of local anaesthetic, start with a needle being used to put a cannula (thin plastic tube) into a vein in the back of your hand or arm. If needles worry you, please tell your anaesthetist. A needle cannot usually be avoided, but there are things he/she can do to help.

Due to individual variation, it may be more difficult to insert a cannula in some patients. Factors like BMI (body mass index), environmental temperature and prolonged fasting/starvation prior to surgery might make the insertion of this needle more challenging. It is rare to start the anaesthetic without this cannula in place. Rarely an ultrasound machine may be needed to assist insertion. An amount of bruising and discomfort may be experienced at the insertion site after the removal of the cannula. The level of bruising may vary based on certain medications and the indiviual’s tendency to bruise. Firm pressure at the site, after removal of the cannula, may reduce this. Very thin/fragile skin tends to bruise more readily. This bruising should resolve after a few days.

Questions you may like to ask your anaesthetist

1. Who will give my anaesthetic?
2. Do I have to have a general anaesthetic?
3. What type of anaesthetic do you recommend?
4. Have you often used this type of anaesthetic?
5. Will I be unconscious and completely unaware during this kind of anaesthetic?
6. What are the risks of this type of anaesthetic?
7. Do I have any special risks?
8. How will I feel afterwards?

Other useful resources to get you prepared for surgery can be found on this website below

https://www.rcoa.ac.uk/patient-information/preparing-surgery-fitter-better-sooner

 

 

 

 

The leaflet is detailed below, or you can download 'Your Spinal Anaesthetic' leaflet in PDF. 

This leaflet explains what to expect when you have an operation with a spinal anaesthetic.  It has been written by patients, patient representatives and anaesthetists, working together. 

You can find more information leaflets on the website www.rcoa.ac.uk/patientinfo.  The leaflets may also be available from the anaesthetic department or pre-assessment clinic in your hospital.

The website includes the following:

• Anaesthesia explained (a more detailed booklet)
• You and your anaesthetic (a shorter summary)
• Epidural pain relief after surgery
• Your anaesthetic for major surgery

Risks Associated With Your Anaesthetic

This is a collection of 14 articles about specific risks associated with having an anaesthetic or an anaesthetic procedure.  It supplements the patient information leaflets listed above and is available on the website: www.rcoa.ac.uk/patients-and-relatives/risks.

Having a Spinal Anaesthetic

This leaflet explains:

• What a spinal anaesthetic is
• How it works, and
• Why you could benefit from having one for your operation.

For many operations, patients receive a general anaesthetic, which produces a state of controlled unconsciousness during the operation.

As an alternative, for operations below the waist, you can have a spinal anaesthetic.  This is when an injection is placed in your back, which makes you numb from the waist downwards.  This means you cannot feel the operation being done.  Depending on your medical condition and the operation you are having, this may be safer or more comfortable for you.

During Your Spinal Anaesthetic, You Can Be:

• Fully awake
• Sedated – drugs make you relaxed and sleepy but not unconscious
• Fully anaesthetised (unconscious).

Your anaesthetist can help you decide which of these would be best for you.

Almost any operation below the waist is suitable for a spinal anaesthetic.  Depending on your personal health, there may be benefits to you from having a spinal anaesthetic.  Your anaesthetist is there to discuss this with you and help you make a decision as to what suits you best.

A spinal anaesthetic is often used for:

• Orthopaedic surgery on joints or bones of the leg
• Groin hernia repair, varicose veins, haemorrhoid surgery (piles)
• Vascular surgery: operations on the blood vessels in the leg
• Gynaecology: prolapse repairs and some kinds of hysterectomy
• Obstetrics: caesarean section
• Urology: prostate surgery, bladder operations, genital surgery.

What Is A ‘Spinal’?

A local anaesthetic drug is injected through a needle into the middle of your lower back, to numb the nerves from the waist down to the toes for two to three hours. Other drugs may be injected at the same time that prolongs pain relief for many hours.

How Is The Spinal Performed?

1. Your anaesthetist will discuss the procedure with you beforehand, on the ward.
2. In the anaesthetic room, you will meet an anaesthetic assistant, who will stay with you during your time in the theatre.
3. The spinal, may be done in the anaesthetic room or in the operating theatre.
4. Your anaesthetist will use a needle to insert a thin plastic tube (a ‘cannula’) into a vein in your hand or arm.
5. You be helped into the correct position for the spinal.  You will either sit on the side of the bed with your feet on a low stool or you will lie on your side, curled up with your knees tucked up towards your chest
6. The anaesthetic team will explain what is happening, so that you are aware of what is taking place ‘behind your back’.
7. The anaesthetist will give you the spinal injection. Local anaesthetic is used in the skin to make the spinal injection more comfortable.  A nurse or healthcare assistant will support and reassure you during the injection.
8. As the spinal begins to take effect, your anaesthetist will test its effectiveness.

What Will I Feel?

A spinal injection is often no more painful than having a blood test or having a cannula inserted.  It may take several minutes to perform.

• Most patients feel no abnormal sensation but as the injection is made you may feel pins and needles or a sharp pain in one of your legs – if you do, try to remain still, and tell your anaesthetist.
• When the injection is finished, you will be asked to lie flat. The spinal works quickly and is usually effective within five to ten minutes. 
• To start with, your skin feels warm, then numb to touch and then gradually your leg muscles become weak.
• When the injection is working fully, you will be unable to move your legs or feel any pain below the waist.

Testing the Block

• Your anaesthetist may use a range of simple tests to see if the block is working properly.
• He/she may spray a very cold liquid on your skin and ask you what you can feel. He/she may ask you to distinguish between cold and wet sensations from the spray.  Please try and simply describe what you can feel and where.  If the feeling of cold is lost at this early stage, this is a good sign that the spinal will work well for the surgery.
• He/she may also ask you to try and move your legs. If you cannot move them, then the spinal is working very well.  If you still have some movement, the anaesthetist will decide if this is significant.

Only when the anaesthetist is satisfied that the anaesthetic has taken effect will he/she allow the surgery to begin.

During The Operation

• In the operating theatre, a full team of staff will look after you. If you are awake, they will introduce themselves and try to put you at your ease. 
• You will be positioned for the operation. Please tell your anaesthetist if there is something simple that will make you more comfortable, such as an extra pillow or armrest. 
• You may be given oxygen to breathe via a lightweight, clear plastic mask, to improve oxygen levels in your blood.
• You will be aware of the ‘hustle and bustle’ of the operating theatre when you come in. Once surgery starts, noise levels drop.  You will be able to relax, with your anaesthetist looking after you. 
• You can listen to music if you wish during the operation. Feel free to bring your own music, with headphones. 
• You can communicate with the anaesthetist during the operation. If an operating camera is used, and there is an extra screen, you may be able to watch the operation on the screen, if you want to. 
• Alternatively, you may be receiving sedation during the operation. You will be relaxed and sleepy but not unconscious. 

However, you may still need a general anaesthetic if:

• Your anaesthetist cannot perform the spinal to his/her satisfaction
• The spinal does not work adequately in the area of the operation
• The surgery is more complicated or takes longer than expected.

After The Spinal

• It takes one to four hours for sensation (feeling) to return to the area of your body that is numb. You should tell the ward staff about any concerns or worries you may have.
• As sensation returns, you may experience some tingling in the skin as the spinal wears off. At this point, you may become aware of some pain from the operation site and you should ask for more pain relief before the pain becomes too obvious. 
• You may be unsteady on your feet when the spinal first wears off. Please ask for help from your nurse when you first get out of bed.
• You can normally drink fluids within an hour of the operation and may also be able to eat a light diet.

Why Have A Spinal?

Advantages compared to having a general anaesthetic

There may be:

• Less risk of a chest infection after surgery
• Less effect on the lungs and the breathing
• Excellent pain relief immediately after surgery
• Less need for strong pain-relieving drugs. This is because the local anaesthetic and any pain relief drugs given in the spinal reduce the need for pain relief medicines given in other ways, which tend to have many more side effects, including nausea, confusion, drowsiness and constipation
• Less sickness and vomiting
• Earlier return to drinking and eating after surgery
• Less risk of becoming confused after the operation, especially if you are an older person.

Side Effects and Complications

As with all anaesthetic techniques, there is a possibility of unwanted side effects or complications.

Very Common and Common Side Effects

These may range from trivial to unpleasant, but can be treated and do not usually last long.

• Low blood pressure – as the spinal takes effect, it can lower your blood pressure. This can make you feel faint or sick.  This will be controlled by your anaesthetist with the fluids given through your drip and by giving you drugs to raise your blood pressure.
• Itching – this can occur as a side effect of using morphine-like drugs in combination with local anaesthetic drugs in the spinal anaesthetic. If you experience itching, it can be treated.  Please let the staff know if you are itchy. 
• Difficulty passing water (urinary retention) – you may find it difficult to empty your bladder normally for as long as the spinal lasts. Your bladder function returns to normal after the spinal wears off.  You may require a catheter to be placed in your bladder temporarily, while the spinal wears off and for a short time afterwards.  Bowel function is not affected by the spinal. 
• Pain during the injection – if you feel pain in places other than where the needle is – you should immediately tell your anaesthetist. This might be in your legs or bottom, and might be due to the needle touching a nerve.  The needle will be repositioned.
• Headache – there are many causes of headache after an operation, including the anaesthetic, being dehydrated, not eating and anxiety. Most headaches get better within a few hours and can be treated with pain relieving medicines. 

A severe and important headache can occur after a spinal injection.  In young women having a spinal for childbirth it happens in around 1 in 200 or 300 spinals. It is much less common in older people having a spinal. This headache gets worse on sitting or standing and improves if you lie down.  If this happens to you, you need to see an anaesthetist for assessment. If you are still in hospital, your nurses and the surgical team will organise this for you.  If you have left hospital, you should seek help from your GP or by attending the emergency department.

Rare Complications

Nerve damage – this is a rare complication of spinal anaesthesia.  Temporary loss of sensation, pins and needles and sometimes muscle weakness may last for a few days or even weeks but almost all of these make a full recovery in time.

Permanent nerve damage is rare (approximately 1 in 50,000 spinals).  It has about the same chance of occurring as major complications of having a general anaesthetic. 

Frequently Asked Questions

Can I Eat and Drink before My Spinal? 

You will be asked to follow the same rules as if you were going to have a general anaesthetic.  This is because it is occasionally necessary to change from a spinal anaesthetic to a general anaesthetic.  The hospital should give you clear instructions about fasting.

Must I Stay Fully Conscious?

Before the operation, you and your anaesthetist can decide together whether you remain fully awake during the operation or would 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.  It is also possible to combine a spinal with a general anaesthetic. 

Will I See What Is Happening To Me?

A screen is placed across your body at chest level, so that you can’t see the surgery.  Some operations use video cameras and telescopes for ‘keyhole’ surgery and some patients like to see what is happening on the screen.  This is only possible if there is a spare screen.

Do I Have A Choice Of Anaesthetic?

Yes.  Your anaesthetist will assess your overall preferences and needs for the surgery and discuss them with you.  If you have anxieties regarding the spinal, then these should be answered during your discussions.

Can I Refuse To Have The Spinal? 

Yes.  If, following discussion with your anaesthetist, you are still unhappy about having a spinal anaesthetic you can always say no.  You will never be forced to have any anaesthetic procedure that you don’t want.

Will I Feel Anything During The Operation?

Your anaesthetist will not permit surgery to begin until he/she are satisfied that the spinal is working properly.  You should not feel any pain during the operation but you may be aware of movement or pressure as the surgical team carry out their work.

Should I Tell The Anaesthetist Anything During The Operation? 

Yes, your anaesthetist will want to know about any sensations or other feelings you experience during the operation.  They will make adjustments to your care throughout the operation and be able to explain things to you.

Is A Spinal The Same As An Epidural?

No. Although they both involve an injection of local anaesthetic between the bones of the spine, the injections work in a slightly different way.

Where Can I Learn More About Having A Spinal?

You can speak to your anaesthetist or contact the pre-assessment clinic or anaesthetic department in your local hospital.  The website: www.rcoa.ac.uk/patientinfo has more information.

Questions You May Like To Ask Your Anaesthetist

1. Why is a spinal a good idea for me?
2. What benefits does it have over alternative techniques for me?
3. Who will give my anaesthetic?
4. Have you often used this type of anaesthetic?
5. Will I be unconscious and completely unaware during this type of anaesthetic?
6. Do I have any special risks?
7. How will I feel afterwards?
8. How will I feel afterwards if I don’t have a spinal?

Tell us what you think

We welcome any suggestions to improve this leaflet.  You should send these to:

The Royal College of Anaesthetists

Churchill House

35 Red Lion Square

London WC1R 4SG

comms@rcoa.ac.uk

Fourth Edition 2014

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© The Royal College of Anaesthetists (RCoA) and Association of Anaesthetists of Great Britain and Ireland (AAGBI)

The RCoA and AAGBI agree to the copying of this leaflet for the purpose of producing local leaflets. Please quote where you have taken the information from. Any changes must be agreed if the AAGBI and RCoA crests are to be kept.

The leaflet is detailed below, or you can download 'Patient Controlled Analgesia (PCA)' leaflet in PDF. 

What Is PCA?

PCA is a system that involves a drip in your arm connected to a machine containing a supply of pain relieving medicine (usually morphine). The machine allows you control of providing your own pain relieving medication, hence the name “Patient Controlled Analgesia”.

When Do I Receive The Medication?

When you wake up in the recovery room, the nurse will connect your PCA pump to your drip. The nurse will place an analgesia request button in your hand that you can start to use as soon as you begin to feel any discomfort.

How Does The PCA Work?

Whenever you feel discomfort or pain, you give yourself a small dose of the medication by pressing and releasing the analgesia request button. As you release the button the pump will automatically deliver a measured dose of medicine.

You are the only person allowed to press the button. This is because you are the only person who knows when you need the pain relieving medication.

When you press and release the button the machine will make a beep noise; this tells you that you have used the button correctly. You may also hear the pump providing you with your dose of analgesia.

What Are The Advantages Of PCA?

There are three main advantages of using PCA.

• You are in control of your own pain relief
• You don’t have to wait for staff to give you the pain relieving medicine
• PCA avoids the need for injections

How Often Should I Press The Button?

No-ones discomfort or pain is the same and everyone requires different amounts of the pain relieving medication. It is important to push the button when you feel uncomfortable and not to wait until the pain has built up.

It is a good idea to push the button before doing anything you think may be uncomfortable, for example getting out of bed, having physiotherapy treatment, or undergoing a nursing procedure, it will help make things more comfortable.

Can I Give Myself Too Much Pain Relieving Medication?

It is very unlikely that you will receive too much pain relieving medication. Once the machine has given you a dose of analgesia it will not give you any more, despite the fact you may continue pressing the button, for a set length of time (to ensure that the dose has worked before more is provided). The length of time is usually 5 minutes.

Are There Any Side Effects?

The analgesia can sometimes make you feel drowsy or light-headed; it can also make you feel sick, constipated or skin feel itchy. It is very important that you tell the nursing staff, so they can give you medication to help relieve this.

How Long Will I Need PCA?

The amount of time for which you will need PCA will vary depending on the type of surgery you have had, how quickly you are recovering, and how much discomfort you still have. You must be able to drink when the PCA is stopped so that it may be replaced with painkilling tablets.

There is no time limit on how long you can use a PCA for. You decide, together with the acute pain nurse and the staff, when you are ready to stop using the PCA. Most patients use PCA for one or two days after their operation.

Before you stop using PCA, you will start to use tablets and perhaps pain relieving suppositories to relieve any discomfort.

Can I Walk Around Whilst Using PCA?

Yes. The machine is attached to a stand on wheels.

Can I Take Other Painkillers Whilst I Am Using The PCA?

Yes. Other painkillers will be used at the same time as your PCA. This reduces the amount of PCA medication you need and reduces its unwanted side effects.

What If I Am Still In Pain?

The ward staff will regularly monitor your pain levels after your operation but occasionally some patients still have pain despite making full use of the PCA and having other milder painkillers.

If your pain is not controlled the nurse will give you another form of painkiller, and / or arrange for the surgeon, on anaesthetist, or acute pain nurse to come and assess you.

What Are The Alternatives To Having A PCA?

You will have the opportunity to discuss the right post-operative pain relief.

The other methods of pain relief available include:

Tablets, Liquids & Suppositories

If you are able to eat & drink the most convenient way to take painkillers is by mouth. We know that combinations of different types of painkillers provide the best pain relief.

Injections

When patients are experiencing a lot of discomfort an injection of a strong pain killer can be given either into a muscle or vein.

Epidural

Epidural analgesia is administered using a small plastic tube which is placed into the epidural space in your back.

There is a separate information leaflet about epidural analgesia available, please ask for a copy if you wish to read more.

I Prefer Not To Take Painkillers Generally, Is It Not Better To ‘Grin and Bear It’?

No. It is extremely important to have good pain relief, as it will enable you to get up and about after your operation. Complications associated with surgery such as a bad chest and bedsores can then be avoided. Good pain relief will allow you to get the rest you need to allow wound healing to take place.

The Acute Pain Team

The anaesthetist or the pain nurse may visit you after your surgery. This will give you further opportunity to ask any questions which may be worrying you and allow us to check that you are satisfied with the pain relief you are receiving.

Painkillers to Take At Home

When you are ready to be discharged from hospital the ward doctors will write a prescription for painkillers along with other medicines that they want you to continue at home.

The painkillers will work most effectively if taken regularly and if they are taken together with regular Paracetamol. You should continue the painkillers until normal day-to-day activities are comfortable.If you are not sure about how or when to take painkillers please ask the doctor or nurse before you are discharged.

Any Other Questions?

Once you are in hospital if you have any questions do not hesitate to ask the ward staff for advice.
The ward staff may arrange for a doctor, anaesthetist or the pain nurse to come and speak to you.

The leaflet is detailed below, or you can download 'Reducing Blood Loss during Surgery' leaflet in PDF. 

Factsheet

During operations, most patients will lose some blood. During bigger operations, or unexpectedly in any surgery, a lot of blood can be lost. The surgeon and anaesthetist aim to minimise the blood lost in order to reduce the problems you may face during and after the operation. In this leaflet we hope to explain some of the techniques we can and may use to minimise the blood lost during surgery.

Cell Salvage

What is Cell Salvage?

This means making the best use of your own blood. Any lost during and after can be returned to you in a drip.

How Is It Done?

When cell salvage is used, blood that is lost during the operation is collected into a machine that filters and washes the blood.

The blood can then be given back to you during the operation or afterwards. It is a technique that is well established in various types of operations.

The cell salvage machine separates the different parts of your blood and collects the red cells. These are the cells that carry oxygen to different parts of your body and are given back to you during or just after your operations.

Your red cells will only ever be given to you and will never be given to anyone else.

Similarly, you will never be given anyone else’s red cells.

What Are The Benefits Of Cell Salvage?

If you lose blood during your operation, cell salvage can help by reducing the need for a blood transfusion donated by a blood donor.

The advantages of this are that you are given a transfusion of your own blood. This reduces the risk of reactions to the wrong blood type occurring or of transmission of infection.

Which Patients Can Benefit From Cell Salvage?

Patients who are undergoing an operation which has a high risk of losing blood can benefit from the use of cell salvage. Also, patients who do not wish to receive blood from a blood donor.

Is It Suitable For All Operations?

No. Not all the operations result in enough blood loss to enable cell salvage to be used. It is not recommended in some operations and your doctor will discuss this with you. Your doctor will be able to advise you if cell salvage is suitable for the operation you are having.

Is It Acceptable for Jehovah’s Witnesses?

This will depend on the views of the individual. Cell salvage is deemed acceptable by many Jehovah’s Witnesses.

Absorbable Cellulose Matrix

In some circumstances, the surgeon may decide to leave an absorbable material within the body to minimise any future bleeding. The material (a cellulose matrix (6-8cm ribbon or 4-5cm square)) is reabsorbed by the body over time, but before this acts as a focus for blood to clot and hence reduces the risk of blooding after the operation.

The matrix (Surgicel, Surgiknit, or Equitamp are several of the products used) is placed over the site thought to be at risk of bleeding and left in place. It can take up to 28 days for it to be completely reabsorbed. If placed above the closed end of the vagina after a hysterectomy, it is possible for the matrix to work its way out through the sutures closing the vagina and be expelled through the vagina. Though this can be both unexpected and alarming, it is not dangerous or a worry for your ongoing recovery.

Is It Suitable For All Operations?

Yes. There is no specific operation where this is not suitable, though it may be more useful in some circumstances, such as where the organs inside were stuck together (perhaps from previous surgery) leaving a raw area.

Topical Thrombin Products

In normal circumstances when you bleed, the body clots by using several chemicals including thrombin to encourage the blood cells to stick together to form a clot. During surgery, we can use those same chemicals to encourage the body to form clots more quickly and so stop bleeding and reduce the chance of future bleeding. Various products (e.g. Floseal) combine a gelatine matrix with Thrombin, which is then sprayed or injected over the bleeding area. The matrix is completely absorbed.

 

Is It Suitable For All The Operations?

Yes. As with the absorbable matrix, it can be more suitable in certain circumstances, such as where the bleeding point is difficult to access with sutures.

Tranexamic Acid

Tranexamic acid is a medicine (injection or tablet) which promotes clotting of the blood. In cases where there is significant blood loss, tranexamic acid can reduce the amount of blood loss as an injection given by the anaesthetist during the operation. It has been used very successfully in surgery for patients with severe trauma (e.g. Car accidents), and there are trials currently underway in Caesarean section and radical hysterectomy to work out just how much benefit it provides.

Is It Suitable For All The Operations?

Not necessarily. The aim of the medicine is to make the blood more likely to clot, so in people who are at high risk of blood clots it may not be appropriate.

Why Have I Been Offered These Treatments?

These treatments may be discussed with you before your operation if you are thought to be at risk of bleeding or if you are anaemic. It may be considered during the operation (whilst you are asleep) if thought the most appropriate treatment during the operation by your surgeon or anaesthetist. If you do not wish any of these treatments to be used, do please tell your surgeon or anaesthetist before the operation.

Can I Get Further Information?

The nursing staff in the pre-operative clinic, your surgeon or your anaesthetist will be happy to answer any further questions.

For further information about these treatments please visit:

www.learncellsalvage.co.uk

www.nice.org.uk

www.nwrtc.co.uk

The leaflet is detailed below, or you can download 'Contraception Advice following the Administration of Sugammadex ' leaflet in PDF. 

Commonly, as part of your anaesthetic, medicines are given to relax your muscles to give the surgeon the best conditions for operating.  The anaesthetic medicines give the anaesthetist the ability to take care of your breathing under anaesthesia.  At the end of your operation, the action of these medicines needs to be reversed before you wake up. One of these ‘reversal’ medicines which you have been given today is called sugammadex (or sometimes it can be referred to as Bridion®). The drug sugammadex may interact with your contraception due to its effect on the hormone progesterone. This may temporarily increase the risk of pregnancy.

If you take the oral contraceptive pill

The progesterone only contraceptive

• ‘mini-pill' Desogestrel
• Levonorgestrel
• Northisterone

The Combined oral contraceptive ‘pill’

If you have taken your pill this morning and have been given Sugammadex, it is the equivalent to one missed pill.

Please follow the missed pill advice in the package leaflet of the oral contraceptive.

If you use any other hormonal contraceptive

Contraceptive implant

• Etonogestrel (Nexplanon®)

Hormonal Intra-Uterine System (IUS)

• Levonorgestrel (Mirena®)
• Jaydess®
• Levosert®
• Kyleena®

The contraceptive injection

• Medroxyprogesterone (Depo-Provera)
• SAYANA® PRESS
• Noristerat®

The contraceptive patch (EVRA 203)

 

You must use a barrier method of contraception, such as condoms, for the next 7 days and follow the advice in the package leaflet of the contraceptive product.

For more information please use the following links

BNF- https://bnf.nice.org.uk/interaction/sugammadex-2.html

https://www.medicines.org.uk/EMC/medicine/21299/SPC/Bridion+100+mg+ml+solution+for+injection/#gref