Surgery on Lower Body
When you have surgery, you need to have an anesthetic.. For surgery on
any part of the body below the ribs, there are several different kinds
of anesthetic one can use. This pamphlet was written to help you decide
which type you would prefer. There may also be special concerns that
apply to you. When you talk with the anesthetist, he or she will answer
any questions you may have. Together, you can decide which anesthetic is
best for you.
Local Anesthesia
A local anesthetic means injecting freezing medicine around the site of surgery. This is very useful for small areas such as a toe or small patch of skin. It is often used for procedures outside the operating room, like your doctor's office. It sometimes does not work well if the surgery involves a large area.
Local anesthesia has several advantages. Compared to regional anesthesia, less area is frozen, so it feels more natural. Compared to general anesthesia, patients tend to feel less drowsy and less nauseated after the surgery. The local anesthetic can keep the area frozen for several hours. This helps with pain control after surgery.
With local anesthesia, you have the choice of being awake or sleepy. The anesthetist can use medication to make you feel relaxed or sleepy if you like.
Local anesthetic is injected with a needle. The needle is very small, and not very uncomfortable. Sometimes, more than one injection is needed.
For surgery on the leg, we often use a tourniquet. This is a tight band used to control bleeding. At the end of the surgery, it is removed. Local anesthesia is usually not comfortable for long procedures that need a tourniquet.
Regional Anesthesia
A regional anesthetic is a nerve block. It is similar to a local, but the freezing is not injected into the site of surgery. Instead, we freeze the nerves that supply the area. This way, we can freeze a much larger area with fewer injections. This is mostly used for surgery on the leg or foot, but is also good for smaller operations on the abdomen.
There are several advantages to regional anesthesia. If the area to be frozen is large, fewer injections are needed than with local anesthesia. There are less drowsiness and nausea than with a general anesthetic. You can be awake or sleepy, just like with a local anesthetic.
Regional anesthesia is similar to local anesthesia. A small needle is used to inject the freezing. This is mildly uncomfortable. Compared to a local anesthetic, more of the body gets frozen. If the freezing is done on a leg, you won't be able to use the leg until it wears off.
The freezing will last from 2 to 24 hours, depending on the type of block and local anesthetic used. Until it does wear off, you have no pain, but you also can't use the leg.
Spinal Anesthesia
A spinal anesthetic is like a regional anesthetic, but the needle is placed between two of the bones in the back into the spinal fluid. This way we freeze all of the nerves from there down. This means both legs as well as the abdomen will be frozen with a very small amount of anesthetic through a single needle.
Spinals have the advantages that they are simple, require only one needle and freeze the lower abdomen better than regional anesthesia can. We don't use spinals that last more than a few hours. That way you get feeling and movement back soon, but will need painkillers sooner than with regional anesthesia.
Epidural Anesthesia
Epidural anesthesia is familiar to most people as a way to treat pain during childbirth. It is actually useful for any pain below the shoulders. It can be used by itself for surgery or for pain relief after a general anesthetic.
Epidurals are like spinals. The needle is placed between two bones in the back, but not all the way into spinal fluid. It feels the same as a spinal, but it allows us to put in a catheter, or small tube, that can stay in for several days to be used for pain relief. After the surgery is over, we can change to a lighter freezing that will help stop the pain, but allow your movement to come back.
With either regional or local anesthesia, it is possible that the freezing will not work well. The freezing is tested before starting the surgery. If it is not working well, we either fix it, or give you a general anesthetic.
General Anesthesia
Most people think of a general anesthetic as going to sleep. A general anesthetic is different from natural sleep. If someone cut you while you were asleep at night you would wake up! A general anesthetic makes you more deeply unconscious, so you don't feel anything.
First, we give you oxygen to breathe from a rubber mask. While you breathe the oxygen, we give you some medication in the intravenous that makes you fall asleep. After you are asleep, we keep you asleep with a combination of gas and intravenous medication.
The main advantage of general anesthesia is that all the medications go into the intravenous tubing. There is no need for more needles. This is very important to some people, and not to others. The disadvantages are that you stay drowsy longer, are more likely to have nausea or vomiting, and are more likely to need painkillers afterward. Sometimes, we need to put a breathing tube into your windpipe after you are asleep. This may cause a sore throat that can last a few days.
Risks of Anesthesia
The risk with any type of anesthetic in healthy people is very low. The chance of dying from an anesthetic is less than one in 50,000 . All anesthetics have a chance of serious complications. Breathing problems are the most common serious problem. Nerve injuries are a rare but sometimes serious complication. The most common question people have about spinal or epidural anesthesia is if it is possible to become paralysed. It is posible, but extremely rare, about 1:150,000. It is also possible to have nreve injuries with regional or general anesthesia, although they only involve single nerves. With regional anesthesia, the risk of nerve injury is very low, but not exactly known. The risk of nerve injury with general anesthesia is about one in three thousand patients. The result of a nerve injury can be losing feeling or strength in some area. Most injuries go away in a few weeks. Very rarely, they can be permanent. Because serious problems are so rare, the difference between anesthetics is more in the minor problems.
Minor problems with local or regional anesthesia are: the need for an injection and being able to feel movement, which some people don't like.
Spinals and epidurals also require an injection. The most common minor problem is a headache, which can occur about 1% of the time. It usually resolves in a day or two, but occasionally a needle in the back is needed to get rid of it.
Minor problems with general anesthetics include nausea, drowsiness, sore throat, and more need for painkillers.
This pamphlet does not cover all the details about the different anesthetics, but explains the important aspects. You will have a chance to discuss any questions with your anesthetist before the surgery. We hope to make your surgical experience comfortable, and wish you a speedy recovery.
Local Anesthesia
A local anesthetic means injecting freezing medicine around the site of surgery. This is very useful for small areas such as a toe or small patch of skin. It is often used for procedures outside the operating room, like your doctor's office. It sometimes does not work well if the surgery involves a large area.
Local anesthesia has several advantages. Compared to regional anesthesia, less area is frozen, so it feels more natural. Compared to general anesthesia, patients tend to feel less drowsy and less nauseated after the surgery. The local anesthetic can keep the area frozen for several hours. This helps with pain control after surgery.
With local anesthesia, you have the choice of being awake or sleepy. The anesthetist can use medication to make you feel relaxed or sleepy if you like.
Local anesthetic is injected with a needle. The needle is very small, and not very uncomfortable. Sometimes, more than one injection is needed.
For surgery on the leg, we often use a tourniquet. This is a tight band used to control bleeding. At the end of the surgery, it is removed. Local anesthesia is usually not comfortable for long procedures that need a tourniquet.
Regional Anesthesia
A regional anesthetic is a nerve block. It is similar to a local, but the freezing is not injected into the site of surgery. Instead, we freeze the nerves that supply the area. This way, we can freeze a much larger area with fewer injections. This is mostly used for surgery on the leg or foot, but is also good for smaller operations on the abdomen.
There are several advantages to regional anesthesia. If the area to be frozen is large, fewer injections are needed than with local anesthesia. There are less drowsiness and nausea than with a general anesthetic. You can be awake or sleepy, just like with a local anesthetic.
Regional anesthesia is similar to local anesthesia. A small needle is used to inject the freezing. This is mildly uncomfortable. Compared to a local anesthetic, more of the body gets frozen. If the freezing is done on a leg, you won't be able to use the leg until it wears off.
The freezing will last from 2 to 24 hours, depending on the type of block and local anesthetic used. Until it does wear off, you have no pain, but you also can't use the leg.
Spinal Anesthesia
A spinal anesthetic is like a regional anesthetic, but the needle is placed between two of the bones in the back into the spinal fluid. This way we freeze all of the nerves from there down. This means both legs as well as the abdomen will be frozen with a very small amount of anesthetic through a single needle.
Spinals have the advantages that they are simple, require only one needle and freeze the lower abdomen better than regional anesthesia can. We don't use spinals that last more than a few hours. That way you get feeling and movement back soon, but will need painkillers sooner than with regional anesthesia.
Epidural Anesthesia
Epidural anesthesia is familiar to most people as a way to treat pain during childbirth. It is actually useful for any pain below the shoulders. It can be used by itself for surgery or for pain relief after a general anesthetic.
Epidurals are like spinals. The needle is placed between two bones in the back, but not all the way into spinal fluid. It feels the same as a spinal, but it allows us to put in a catheter, or small tube, that can stay in for several days to be used for pain relief. After the surgery is over, we can change to a lighter freezing that will help stop the pain, but allow your movement to come back.
With either regional or local anesthesia, it is possible that the freezing will not work well. The freezing is tested before starting the surgery. If it is not working well, we either fix it, or give you a general anesthetic.
General Anesthesia
Most people think of a general anesthetic as going to sleep. A general anesthetic is different from natural sleep. If someone cut you while you were asleep at night you would wake up! A general anesthetic makes you more deeply unconscious, so you don't feel anything.
First, we give you oxygen to breathe from a rubber mask. While you breathe the oxygen, we give you some medication in the intravenous that makes you fall asleep. After you are asleep, we keep you asleep with a combination of gas and intravenous medication.
The main advantage of general anesthesia is that all the medications go into the intravenous tubing. There is no need for more needles. This is very important to some people, and not to others. The disadvantages are that you stay drowsy longer, are more likely to have nausea or vomiting, and are more likely to need painkillers afterward. Sometimes, we need to put a breathing tube into your windpipe after you are asleep. This may cause a sore throat that can last a few days.
Risks of Anesthesia
The risk with any type of anesthetic in healthy people is very low. The chance of dying from an anesthetic is less than one in 50,000 . All anesthetics have a chance of serious complications. Breathing problems are the most common serious problem. Nerve injuries are a rare but sometimes serious complication. The most common question people have about spinal or epidural anesthesia is if it is possible to become paralysed. It is posible, but extremely rare, about 1:150,000. It is also possible to have nreve injuries with regional or general anesthesia, although they only involve single nerves. With regional anesthesia, the risk of nerve injury is very low, but not exactly known. The risk of nerve injury with general anesthesia is about one in three thousand patients. The result of a nerve injury can be losing feeling or strength in some area. Most injuries go away in a few weeks. Very rarely, they can be permanent. Because serious problems are so rare, the difference between anesthetics is more in the minor problems.
Minor problems with local or regional anesthesia are: the need for an injection and being able to feel movement, which some people don't like.
Spinals and epidurals also require an injection. The most common minor problem is a headache, which can occur about 1% of the time. It usually resolves in a day or two, but occasionally a needle in the back is needed to get rid of it.
Minor problems with general anesthetics include nausea, drowsiness, sore throat, and more need for painkillers.
This pamphlet does not cover all the details about the different anesthetics, but explains the important aspects. You will have a chance to discuss any questions with your anesthetist before the surgery. We hope to make your surgical experience comfortable, and wish you a speedy recovery.