GENERAL INFORMATION:
delivery MECHANISMS
Regional Anaesthesia
Regional anaesthesia is the science of injecting local anaesthetic drugs around the nerves that supply sensation to the area of your surgery. This is referred to as a "nerve block". Nerve blocks can be performed as the sole form of analgesia (in other words, the "block" is performed with the patient awake and provides sufficient pain relief for the surgery to be performed with the patient awake) or as supplemental analgesia (the patient is given a general anaesthetic for the surgery and the "block" is performed purely for post-operative pain relief).
Regional anaesthesia is the science of injecting local anaesthetic drugs around the nerves that supply sensation to the area of your surgery. This is referred to as a "nerve block". Nerve blocks can be performed as the sole form of analgesia (in other words, the "block" is performed with the patient awake and provides sufficient pain relief for the surgery to be performed with the patient awake) or as supplemental analgesia (the patient is given a general anaesthetic for the surgery and the "block" is performed purely for post-operative pain relief).
Epidurals
Epidural anaesthesia involves the placement of a needle between two of the vertebrae of the spine to reach the so-called "epidural space". This is the area just outside of the fibrous sac that surrounds the spinal chord. All the nerve roots leaving the spinal chord pass through this space, and by injecting local anaesthetic drugs into this space, the Anaesthesiologist can "numb" certain areas of the body. Often, an epidural catheter (a very tiny plastic tube) is placed through the needle before the needle is removed. This catheter enables us to keep the epidural working for as long as it is needed.
Although it sounds fairly daunting, an epidural is generally a painless procedure as the skin is anaesthetized with local anaesthetic prior to the epidural injection. Patients are normally only aware of some pressure on the spine. Epidurals can be performed with the patient either awake or asleep.
Epidurals are widely used for:
Epidural anaesthesia involves the placement of a needle between two of the vertebrae of the spine to reach the so-called "epidural space". This is the area just outside of the fibrous sac that surrounds the spinal chord. All the nerve roots leaving the spinal chord pass through this space, and by injecting local anaesthetic drugs into this space, the Anaesthesiologist can "numb" certain areas of the body. Often, an epidural catheter (a very tiny plastic tube) is placed through the needle before the needle is removed. This catheter enables us to keep the epidural working for as long as it is needed.
Although it sounds fairly daunting, an epidural is generally a painless procedure as the skin is anaesthetized with local anaesthetic prior to the epidural injection. Patients are normally only aware of some pressure on the spine. Epidurals can be performed with the patient either awake or asleep.
Epidurals are widely used for:
- Labour pains and caesarean sections
- Post-operative pain control following knee or hip replacement surgery
- Post-operative pain control following surgery to the major body cavities (e.g abdominal surgery or chest surgery)
Spinals
Spinal anaesthesia involves the placement of a small needle between two of the vertebrae of the spine to reach the so-called "spinal space". This is the area inside the fibrous sac that surrounds the spinal chord and it is filled with fluid. By injecting local anaesthetic drugs into this fluid, the Anaesthesiologist can "numb" certain areas of the body. This usually leads to muscle weakness in the area anaesthetized. However, this weakness is temporary and normal muscle strength returns as soon as the spinal wears off after a few hours.
As is the case with epidurals, spinals are generally painless procedures as the skin is anaesthetized with local anaesthetic prior to the spinal injection. Patients are normally only aware of some pressure on the spine. Spinals can be performed with the patient either awake or asleep and are often used as the only form of anaesthetic so that the patient can be awake during the surgical procedure.
Spinals are widely used for:
Spinal anaesthesia involves the placement of a small needle between two of the vertebrae of the spine to reach the so-called "spinal space". This is the area inside the fibrous sac that surrounds the spinal chord and it is filled with fluid. By injecting local anaesthetic drugs into this fluid, the Anaesthesiologist can "numb" certain areas of the body. This usually leads to muscle weakness in the area anaesthetized. However, this weakness is temporary and normal muscle strength returns as soon as the spinal wears off after a few hours.
As is the case with epidurals, spinals are generally painless procedures as the skin is anaesthetized with local anaesthetic prior to the spinal injection. Patients are normally only aware of some pressure on the spine. Spinals can be performed with the patient either awake or asleep and are often used as the only form of anaesthetic so that the patient can be awake during the surgical procedure.
Spinals are widely used for:
- Labour pains and epidural caesarean sections
- Knee or hip surgery
- Many urological procedures such as prostate surgery
Peripheral Nerve Blocks
Peripheral nerve blocks are the latest and fastest growing form of regional anaesthesia.
Here, local anaesthetic is injected around specific nerves that supply the sensation to various body regions. Unlike spinals and epidurals (where the numbness is usually experienced on both sides of the body), peripheral nerve blocks are normally one-sided and "more focussed" on the area of surgery. To find the nerve, the needle is connected to a device known as a nerve stimulator which sends tiny electrical impulses enabling the Anaesthesiologist to accurately find the nerve or the needle and nerve is visualised with a sonar machine.
There are a vast number of uses for peripheral nerve blocks. For example, a sciatic nerve block gives excellent pain relief for ankle surgery while an interscalene block enables patients to undergo effective physiotherapy following shoulder surgery. Although used most commonly in orthopaedic surgery, certain forms of peripheral nerve blocks are extremely useful in breast surgery and surgery of the head and neck.
Peripheral nerve blocks are the latest and fastest growing form of regional anaesthesia.
Here, local anaesthetic is injected around specific nerves that supply the sensation to various body regions. Unlike spinals and epidurals (where the numbness is usually experienced on both sides of the body), peripheral nerve blocks are normally one-sided and "more focussed" on the area of surgery. To find the nerve, the needle is connected to a device known as a nerve stimulator which sends tiny electrical impulses enabling the Anaesthesiologist to accurately find the nerve or the needle and nerve is visualised with a sonar machine.
There are a vast number of uses for peripheral nerve blocks. For example, a sciatic nerve block gives excellent pain relief for ankle surgery while an interscalene block enables patients to undergo effective physiotherapy following shoulder surgery. Although used most commonly in orthopaedic surgery, certain forms of peripheral nerve blocks are extremely useful in breast surgery and surgery of the head and neck.
Patient Controlled Analgesia (PCA)
Following surgery, the patient is connected to a PCA-machine which is essentially a computerised drip. This piece of equipment constantly provides the patient with a sustained level of pain relief. What makes PCA unique is that the machine has a push button that you press yourself when you need pain medication, on demand, every few minutes until such time as you are comfortable. When the button is pressed by the patient, the machine administers and additional dose of pain medication.
This leaves the patient truly in control of his/her own pain treatment. There is no need to ask nursing staff to administer pain medication. The PCA-machines are individually programmed by the Anaesthesiologist in theatre. This programme includes certain safety mechanisms so that it is virtually impossible for the patient to administer "too much" medication. The controls of the PCA-machine are also locked electronically by the Anaesthesiologist so that the settings cannot be changed by anyone else.
Following surgery, the patient is connected to a PCA-machine which is essentially a computerised drip. This piece of equipment constantly provides the patient with a sustained level of pain relief. What makes PCA unique is that the machine has a push button that you press yourself when you need pain medication, on demand, every few minutes until such time as you are comfortable. When the button is pressed by the patient, the machine administers and additional dose of pain medication.
This leaves the patient truly in control of his/her own pain treatment. There is no need to ask nursing staff to administer pain medication. The PCA-machines are individually programmed by the Anaesthesiologist in theatre. This programme includes certain safety mechanisms so that it is virtually impossible for the patient to administer "too much" medication. The controls of the PCA-machine are also locked electronically by the Anaesthesiologist so that the settings cannot be changed by anyone else.
Systemic Analgesia
Systemic analgesics are any pain killing drugs administered by intravenous methods, intramuscular injections, subcutaneously (under the skin), rectally or by mouth. Drugs that are commonly used include morphine, tramadol, pethidine, paracetamol, aspirin, codeine, anti-inflammatories and numerous others.
For acute pain, morphine still remains the most trusted drug on the market. Many patients believe they are "allergic to morphine". However, what they have experienced in the past is not an allergy, but normal side effects of morphine. These include itching, nausea, constipation and vomiting. A number of drugs are available to counteract these side effects and these can be prescribed for you by your Anaesthesiologist. If, however, you have experienced any difficulty in breathing following the administration of morphine or any of its derivatives, please tell your Anaesthesiologist.
Systemic analgesics are any pain killing drugs administered by intravenous methods, intramuscular injections, subcutaneously (under the skin), rectally or by mouth. Drugs that are commonly used include morphine, tramadol, pethidine, paracetamol, aspirin, codeine, anti-inflammatories and numerous others.
For acute pain, morphine still remains the most trusted drug on the market. Many patients believe they are "allergic to morphine". However, what they have experienced in the past is not an allergy, but normal side effects of morphine. These include itching, nausea, constipation and vomiting. A number of drugs are available to counteract these side effects and these can be prescribed for you by your Anaesthesiologist. If, however, you have experienced any difficulty in breathing following the administration of morphine or any of its derivatives, please tell your Anaesthesiologist.
This information was reproduced from the South African Society of Anaesthesiologists (SASA) website Patient Corner page with permission from the webmaster (http://www.sasaweb.com)