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What is a local anaesthetic?
A local anaesthetic is a drug that is injected into the tissues to make them numb. Your anaesthetic will be given to you either by your surgeon or by your anaesthetist (doctor trained in anaesthesia).
A local anaesthetic has been recommended for your operation. However, it is your decision to go ahead with a local anaesthetic or not. This document will give you information about the benefits and risks to help you make an informed decision.
If you have any questions that this document does not answer, you should ask your surgeon or anaesthetist, or any member of the healthcare team.
How does a local anaesthetic work?
Local anaesthetics temporarily stop nerves working so that you do not feel pain. The simplest form of local anaesthesia is to inject the drug just around the area where the operation is going to take place. This tends to sting or burn for a few seconds and then the area goes numb. The feeling of pain goes away much sooner than the feeling of touch, so do not be alarmed if you can still feel pressure or movement. It is possible to numb all the nerves to an arm or a leg (called a regional block).
The procedure will not start until you and your surgeon are both satisfied that the area is numb to pain.
Although the starting area is numb, the operation may reach areas that have not been numbed. If this happens, your surgeon will give you some more local anaesthetic until those areas are numb to pain.
Local anaesthetics generally work for a few hours, depending on the type of drug and dose used. After this time the area should go back to normal.
Are there any alternatives to a local anaesthetic?
If you are concerned about being awake during the operation, it may be possible for it to be performed under a general anaesthetic. However, there are complications associated with a general anaesthetic. Other anaesthetic procedures may be possible such as an epidural or regional block, although these also use local anaesthetic drugs. Sometimes it may be possible to use a sedative as well as a local anaesthetic.
What can I do to help make the operation a success?
• Lifestyle changes
If you smoke, try to stop smoking now. Stopping smoking several weeks or more before an operation may reduce your chances of getting complications and will improve your long-term health.
For help and advice on stopping smoking, go to www.gosmokefree.co.uk.
You have a higher chance of developing complications if you are overweight.
For advice on maintaining a healthy weight, go to www.eatwell.gov.uk.
Regular exercise can reduce the risk of heart disease and other medical conditions, improve how your lungs work, boost your immune system, help you to control your weight and improve your mood. Exercise should help to prepare you for the operation, help with your recovery and improve your long-term health.
For information on how exercise can help you, go to www.eidoactive.co.uk.
Before you start exercising, you should ask a member of the healthcare team or your GP for advice.
What complications can happen?
The healthcare team will try to make your anaesthesia as safe as possible. However, complications can happen. Some of these can be serious and can even cause death. The possible complications of a local anaesthetic are listed below. Any numbers which relate to risk are from studies of people who have had a local anaesthetic. Your doctor may be able to tell you if the risk of a complication is higher or lower for you.
• Not enough pain relief, which is usually corrected by giving more local anaesthetic. Occasionally other forms of drugs or anaesthetic have to be given as well. Let your surgeon know if you are in pain.
• Allergic reaction to local anaesthetics. This is unusual. Many people have been told, or think, they are allergic to local anaesthetic given at the dentist. This is rarely the case, but you should let the person giving your local anaesthetic know about any problems you have had in the past.
• Bleeding, if the needle used to inject the local anaesthetic strikes a blood vessel. This usually results in a small bruise that will not cause problems.
• Nerve damage (risk: 1 in 5,000). Occasionally the local anaesthetic has a longer effect than expected (up to 48 hours) but this usually settles.
• Absorption into the bloodstream, if the local anaesthetic is accidentally injected into the bloodstream or if it is absorbed into the bloodstream more quickly than usual. This is rare but can cause various problems temporarily affecting the heart and brain, which can be serious. The dose of local anaesthetic is always limited to reduce this risk.
You should discuss these possible complications with your surgeon or anaesthetist if there is anything you do not understand.
A local anaesthetic can be used for most people, giving a safe and effective form of pain relief both during and after your operation. However, complications can happen. You need to know about them to help you make an informed decision about your anaesthetic. Knowing about them will also help to detect and treat any problems early.
• NHS smoking helpline on 0800 169 0 169 and at www.gosmokefree.co.uk
• www.eatwell.gov.uk – for advice on maintaining a healthy weight
• www.eidoactive.co.uk – for information on how exercise can help you
• www.aboutmyhealth.org – for support and information you can trust
• Association of Anaesthetists of Great Britain and Ireland at www.aagbi.org
• Royal College of Anaesthetists at www.rcoa.ac.uk
• Royal College of Anaesthetists and Association of Anaesthetists of Great Britain and Ireland at www.youranaesthetic.info
• NHS Direct on 0845 46 47 (0845 606 46 47 – textphone)
Disclaimer: The views expressed in this article are not necessarily those of Orthopaedic Opinion Online or the author. The information is provided for general background reading only and should not be relied upon for treatment. Advice should always be taken from a registered medical practitioner for individual circumstances and for treatment of any patient in any circumstances. No liability is accepted by Orthopaedic Opinion Online, or the author in respect to the information provided in respect of the content or omission or for any reason or as a result of treatment in individual circumstances. This information is not for use in the USA.