Anaesthesia: More myths than reality?

I worked with a South African consultant during my stint in England. I learnt a lot of tricks but the most important thing I learnt was ?every patient worries about the Pain after surgery and the visit for stitch removal?. He took great pains to make sure that the surgery was always painless. I would like to share with you what I can do as a surgeon to make sure my patients are ?painless?!

Painless surgery revolves around good anaesthesia techniques. Unfortunately lay public has more misunderstandings about anaesthesia than the surgery itself. The reason is easy to understand. All patients know their surgeon well and get a chance to talk to them many times during and after their surgery, however no one even remembers the anaesthetist!


Here are few things which need to be clarified.

It is a good practice to see the anaesthetist on out patient basis before any elective surgery. All major hospitals now have anaesthesia OPD for the same. An Anaesthetist not only can assess the medical and other related issues well before the surgery but can also answer all the questions one may have.

A prior assessment also helps the anaesthetist to prepare himself with all eventualities. Example, a patient with history of back surgery or a deformed spine may not be a candidate for spinal anaesthesia.

Many patients believe that ?general ?anaesthesia is ?dangerous ?and ?local? anaesthesia is safer! It is important to realise here that a good anaesthetist is what you need and he is the BEST judge to decide what is good and what is bad for you!

Spinal or epidural anaesthesia is never a cause of long term back ache! Almost all ladies who have taken a needle in the back feel that all backaches are a result of that needle!

We use what is known as combined ?Spinal-Epidural? aneshtheisa for most of the surgeries in the lower limbs. Let?s see what we do in this technique.

The patient is made to sit up like this

Patient?s back is painted with antiseptic solution.
A small area is then anesthetized with local anaestetic. An epidural needle is then inserted through the numb area as shown below.

Once the placement is correct a tiny tube called epidural cathet er is threaded through this needle as shown below.

This catheter is attached to a machine called an epidural pump which keps pumping a tiny amount of anethetic agent in to your back for the next 3 days. This ensures that you do not get any pain for 3 days after the surgery! Please remember that ?painless? surgery therefore is not a myth but reality.

Patients who get operated for upper limb or back surgeries or those who can not be given an epidural anaesthesia can be given what is known as ? Patient controlled anaesthesia?. Here a pump is set up with required doses of analgesic agents and the patient has a button in his own hand which he presses if ther is any pain.

There are various other techniques called ? local blocks? which also can be used with or as stand alone techniques.
In short remember to discuss your anaesthesia with the surgeon and preferably met your anaesthesiologist before any elective surgery. It is important to realize that with technological advances most of the anaesthesia techniques have a very high margin of safety. Advanced anaesthesia techniques discussed may not be available in small nursing home but are available in most of the leading hospitals. Using local blocks is however is very cost effective and possible in small setups.

Finally ?Painless? surgery is what you should expect in all situations in today?s world.