ANAESTHETICS
ANAESTHETIC DEPARTMENT
PATIENT INFORMATION ABOUT ANAESTHETICS
FOR OPERATIONS
ON THE LEG (INCLUDING HIP AND KNEE REPLACEMENTS)
Please read this information carefully.
It is important that you take note of any instructions or advice
given.
Introduction
This leaflet aims to give you some information about the anaesthetic
and pain relief you may receive when you come into Harrogate District
Hospital for surgery on your leg. An anaesthetist will come to
see you before your operation and discuss your anaesthetic with
you. This is a good time to ask any questions and discuss any
worries you may have. Additionally, you may like to visit www.youranaesthetic.info
, where you will find a number of leaflets from the Royal College
of Anaesthetists which may also be helpful.
Anaesthetic Types
There are 3 main types of anaesthetic performed at Harrogate District
Hospital. They are:
- 1) A General Anaesthetic
- 2) A Spinal Anaesthetic
- 3) A Nerve Block
Sometimes you may receive a combination of these.
1) A General Anaesthetic
If you have a general anaesthetic, you will be asleep throughout
your operation. You will be given drugs to keep you asleep and
also strong pain killers. A general anaesthetic can be used for
any length of operation – from a few minutes to many hours.
When the operation is finished, you will wake after about 5-10
minutes, although your may not remember much for the first half
hour.
Advantages:
- You are completely unaware of anything at all during the operation.
Disadvantages and Side Effects:
- The anaesthetic itself does not provide any pain relief for
after the operation. You will therefore need strong painkillers.
These sometimes make people feel sick or drowsy.
- Many people develop a sore throat and dry mouth for a few hours
after the operation
- Sometimes you can feel or even be sick. This is more common
if you have suffered from it before, so please tell your anaesthetist
if it has been a problem. There are medicines available to treat
sickness should it occur.
- Older people may become confused and forgetful, but this is
usually temporary
- Although uncommon, it is possible to damage your lips, gums
or teeth (particularly caps, crowns and bridgework)
2) A Spinal Anaesthetic
A very fine needle is used to inject local anaesthetic around
the nerves at the base of your back. This will make you go numb
from about the tummy-button downwards. Your legs will go very
heavy (in fact you may not be able to move them at all for a few
hours).
Advantages:
- You will need less strong pain killers in the first few hours
after the operation
- You are less likely to be sick or drowsy. This means you should
be able to eat and drink much sooner
- You can be given sedation during the operation, which means
that you do not see or hear things if you do not wish to! Some
people like to listen to music through headphones, whilst others
just catch up on some sleep
- You are less likely to suffer a blood clot in your legs or your
lungs
- There may be less bleeding, and you may be less likely to need
a blood transfusion
- If you suffer from any chest diseases you may have fewer problems
with your breathing
Disadvantages and Complications:
- Sometimes it is not possible to perform the injection, particularly
if you have any problems with the bones in your back
- Occasionally your legs do not go numb enough. If this happens,
either the injection can be repeated or you can have a general
anaesthetic as well
- The needle may leave a small bruise on your back, which may
be slightly sore for a few days. It does not cause long term back
ache
- There is a small chance of developing a headache afterwards
(less than 1 in 100 patients suffer from this).
- Whenever a needle is put into any part of your body, no matter
how much care has been taken, a few things can happen by accident
such as letting in infection or causing bleeding. It is also possible
to damage a nerve. This is so rare that it is not possible to
give an accurate chance of it happening. It is estimated to be
between 1 in 5,000 and 1 in 30,000.
3) A Nerve Block
This involves injecting local anaesthetic around one or more of
the nerves in the leg. This is sometimes performed with you awake,
although it may also be done after you have had some sedation
or under general anaesthetic. After the operation, your leg may
feel numb and heavy for some hours afterwards.
Advantages:
- The block should provide pain relief for a number of hours afterwards
- Because you need less strong painkillers, you may feel less
drowsy and sick. If you have a general anaesthetic too, this is
often “lighter”, so again you may feel less drowsy.
- Only the leg which has been operated on feels numb (unlike a
spinal anaesthetic, which affects both legs)
Disadvantages and Complications:
- Sometimes the block does not work as well as expected. If this
happens, you will still be given enough painkillers to make you
comfortable
- Occasionally the numbness in your leg can last around 24 hours.
This may mean you have to stay in bed after your operation for
a short time
- Very occasionally, the nerve may be bruised or damaged. This
is sometimes due to the needle itself, but may also be due to
infection, bleeding around the nerve, poor blood supply to the
leg, the position of your leg during the surgery or sometimes
the operation itself. Symptoms such as numbness, pins-and-needles,
pain or weakness lasting up to a week are seen after between 1
and 5 out of every 100 nerve blocks (1-5%). Around 95% of these
fully recover within 4-6 weeks, and 99% have recovered within
a year. Permanent nerve damage is so rare that precise numbers
are not available. One estimate is that it might happen in between
1 in 5000 and 1 in 30,000 nerve blocks.
All Types of Anaesthetic share a number of Potential Complications
- After the operation, some people have difficulty in passing
water. This is more common in men and more likely after a spinal
anaesthetic. It may require treatment by passing a small tube
into the bladder for a day or so.
- Heart attacks and strokes are uncommon after anaesthetics. The
risks of these happening are related to your general health and
fitness. If you are felt to be high risk, it will be discussed
with you by your anaesthetist
- You will be given a number of different medicines during your
stay. It is very important that you tell your anaesthetist if
you have any allergies. It is of course possible that you could
have an allergy for the first time during your stay.
Pain Relief after your Leg Surgery
It is very important that you are comfortable after your surgery,
as you will need to begin exercising your leg as soon as possible.
If you are in pain, do not hesitate to tell the ward staff. They
will either give you additional pain killers or ensure your medication
is changed. Remember everyone’s pain is different –
some people need more painkillers, and some will need less.
A number of methods are used in Harrogate which supplement any
painkillers you received with your anaesthetic.
1) Paracetamol
Paracetamol is a very widely used painkiller. It is usually given
by mouth and has very few side effects. When given regularly,
it can reduce the amount of stronger painkillers required.
2) Anti-inflammatory Painkillers
(NSAIDs)
These include drugs such as ibuprofen (Brufen), diclofenac (Voltarol),
celecoxib (Celebrex) and aspirin. Like paracetamol, they too can
reduce the amount of stronger painkillers you may need. However,
they are not suitable for all patients. They can irritate your
stomach, and occasionally affect how your kidneys work. A small
number of patients with asthma sometimes find they become wheezy
if they take NSAIDs. Therefore they are generally used only in
a selected group of patients.
3) “Strong” Pain Killers
These range from the milder drugs such as codeine and tramadol,
up to the stronger drugs pethidine and morphine. They can usually
be given by mouth or as an injection. We can also give you morphine
using a PCA (see below). Although they are excellent painkillers,
they may cause some side effects. Some patients develop a very
dry mouth, feel sick or dizzy, and in high doses they can make
you feel drowsy. They can also cause constipation. Sometimes if
you get side effects from one drug, we can try a different one.
4) PCA (Patient Controlled Analgesia)
This is one commonly used way to give you morphine, usually
only for the first day or so after your operation. We connect
a small machine to the plastic drip in your arm. You are given
a button to press every time you feel pain. When pressed, a small
amount of morphine goes straight into your blood. It will start
to work within minutes. You can use it as much or as little as
you need. Do not worry about getting an overdose – the machine
will only allow one dose every few minutes. If you are using it
too much, you will become sleepy and therefore unable to press
the button anymore. It is vital that you are the only person to
press the button -don’t hand it to a relative to press for
you!
Many patients are worried about using strong painkillers in case
they become addicted. If you use them when you have pain, you
will not become addicted.
We hope to make your forthcoming visit to Harrogate District
Hospital as comfortable as possible. Please remember that if you
do have any questions or concerns, your anaesthetist will be very
happy to discuss them with you.
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