Controlling pain after your operation

You may offered a regional anaesthetic in addition to a general anaesthetic or sedation. A regional anaesthetic is a specialised technique whereby local anaesthetic is administered in order to numb the area being operated on. This procedure is typically done to relieve pain after your operation. It has the benefit of reducing the amount of stronger pain medications you might need, such as morphine. As a result, this may help by reducing nausea & sedation, which are common side effects of these medications.

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Shoulder surgey

Interscalene or brachial plexus block

Shoulder surgery is painful despite the use of minimally invasive or camera techniques. I recommend an injection of local anaesthetic once you are asleep to control your pain over the next 12-24hrs.

The nerves that supply the shoulder run down the side of your neck. I inject local anaesthetic around these nerves under ultrasound guidance. You will find the shoulder to be numb when you wake up and your arm will feel very heavy. 

People often describe the arm as feeling larger than it really is after this injection. This is not unpleasant, just to be expected. As the anaesthetic wears off, the arm will begin to tingle (pins and needles).


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Hip surgery

Spinal

​It it not necessary to have a full general anaesthetic for a hip replacement (or a knee replacement). I offer patients a spinal anaesthetic with sedation (or a general anaesthetic). 

A spinal involves an injection of local anaesthetic into the fluid that surrounds the spinal cord. It is essentially a 'lumbar puncture', which you may have heard of. Your legs and the lower half of your body will be completely numb for approximately 4hrs. This allows ample time for the surgery to be completed.

I put morphine into the spinal injection which lengthens the pain relief experienced for up to 24hrs after surgery. This may cause some itching and nausea. A spinal will reduce the amount of intra venous morphine requirements immediately after surgery, and improves the quality of your post-operative recovery.

Knee Surgery

Adductor canal catheter

It is very important that patients are able to move their knee after surgery without pain in order to undergo physiotherapy as soon as possible.  This helps strengthen the muscles and improve stability of the joint.

​Once you are asleep, or have had a numbing injection in the back (spinal anaesthetic- see Hip Surgery), I will put an injection in the mid-thigh. A small catheter is inserted under the skin and is left in place after the operation for approximately 2 days. Local anaesthetic runs into the catheter and around the nerve that supplies the knee.

This injection makes the front of the knee numb but does not usually affect the strength of the leg muscles, thereby allowing you to walk. You will still have some discomfort at the back of the knee for which we will give pain relief.
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Children: Penile or lower body surgery

Caudal

A caudal is an injection of local anaesthetic into the fatty space that surrounds the spinal cord. If you are familiar with an epidural, it is essentially an epidural which is done lower down at the level of the buttocks. 

​I offer this procedure to children who are undergoing a variety of procedures in the lower half of their body: e.g. Circumcision/ Hernia repair/ Orchidopexy/ Hypospadias/Hydrocele.

A caudal will be done once your child is asleep. The benefits last up to about 8hrs after the procedure.  This improves the quality of their experience, improves their 'wake-up', and reduces the requirement for stronger pain medicines of the morphine group.

Your child will be a bit wobbly on their legs for a few hours after surgery as the caudal reduces leg strength. This wears off rapidly. The benefits of the pain relief outlast this leg weakness.

Risks of Regional Anaesthesia

All regional procedures are carried out in accordance with the Australian & New Zealand College of Anaesthetists standards.

​Whenever a  needle is inserted into the body to inject local anaesthetic, you may experience bruising or mild tenderness at the site of injection. 
The risk of introducing infection is low.  I follow aseptic or sterile technique as required for each individual procedure.

There is a small risk of damage to the nerve itself. This is very rare. It may lead to numbness or weakness that outlasts the expected duration of the procedure. This mostly resolves over time but may be permanent. I use Ultrasound when appropriate for the majority of techniques, this improves accuracy and reduces the chance of nerve damage.

I will go through these risks in more detail before you decide whether to have the procedure.

Frequently asked questions

Why have a regional when I'll be asleep anyway?

All patients require pain relief even whilst they are asleep, otherwise they would wake up in severe pain. Strong pain medications often give patients side effects such as nausea, vomiting, itching, dizziness and sedation. Some patients would rather not experience these side effects upon waking and would rather the surgical area be numb when they wake up.
A regional will reduce the amount of strong pain medications that would otherwise be required after your operation.

We have found patients that are comfortable immediately after surgery often experience less debilitating pain overall, thus making a swifter recovery. 

I am worried about the risk, what is the alternative to a regional?

When patients decide they would rather not have a regional anaesthetic, I give a combination of medications to control pain. I start with the simple medications such as panadol and ibuprofen, working up to the stronger ones such as Tramadol and Morphine. The stronger ones are weaned off as you no longer need them leaving the weaker ones with fewer side effects.
If you undergo very painful surgery, you may be offered a 
'morphine drip'. You will be given a button to press when you feel pain, the machine will deliver a safe amount of morphine or an alternative pain medication if you are sensitive to morphine. You cannot overdose accidentally with this system.

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