Patient Anaesthetic Information

Dear         

An epidural injection can be given for one of the following possible reasons:

1. On the recommendation of an Orthopaedic Surgeon in the management of back complaints.
2. To manage post-operative or labour pain.

A c omputerized infusion pump that continuously supplies the local anaesthetic drug via an epidural catheter can also be used in the long term management of pain.

Epidural injections are safe and very effective in controlling pain. They are administered by an Anaesthesiologist who will also explain the technique to you. Please ask the Anaesthesiologist during the pre-operative visit to clarify any uncertainty you may have.

Anaesthesiolo ists exercise extreme care in administering epidural injections and infusions but, as with any medical procedure, complications can occur. The following complications are possible:

Common complications:

1. Cardiovascular: Your blood pressure may drop and you may feel lightheaded or dizzy. It is easy to treat this quickly and effectively.

2. Nausea: This is also easily treated.

3. Shivering

4. Difficulty in passing urine: Patients who have had an epidural are not permitted to leave the hospital before they are able to pass urine. Occasionally patients require a urinary catheter and have to be kept in hospital overnight. Patients with an epidural catheter for a constant infusion usually have their bladders catheterized until the epidural is stopped.

Rare complications:

1. Failed block: In rare cases the epidural injection may give unsatisfactory pain relief. The dosage of epidural drugs can then be adjusted or alternative methods of pain relief can be employed.

2. Headache: In some cases the outer covering of the spinal cord is inadvertently punctured and spinal fluid can leak through the defect caused. This can lead to headache which can respond to bed rest for a few days. If this is not effective a sample of your own blood c an be withdrawn and injected aseptic ally into the space around the spinal chord to stop the leak.

3. Backache: You may suffer superficial pain of variable duration at the injection site.

4. Prolonged or dense block: We strive to give the minimum amount of local anaesthetic needed to provide satisfa tory analgesia without interfering with limb movement.

However, sometimes a block can have a prolonged or even a temporary paralyzing effect.

Very rare complications:

1. Haematoma (bleeding): Small blood vessels can be damaged during insertion of the epidural needle. In rare cases this can cause continuous internal bleeding. The resultant pressure on the spinal chord can lead to neurological damage and paralysis if not diagnosed and treated timeously. This treatment involves urgent surgical drainage of the haematoma. It is important that the attending Anaesthesiologist is made aware of any medication, including herbal products, that you are taking and that may interfere with blood clotting and thus may increase the risk of a spinal haematoma forming.

2. Spinal block/ high block: If the unlikely event of the injected local anaesthetic entering the spinal fluid a very dense block that temporarily paralyzes the arms and the muscles of breathing can occur.

3. Sepsis: In spite of the strict aseptic techniques used, superficial skin infections or even an abcess close to the spinal chord are possible.

4. Neurological damage: This can occur during insertion of the epidural needle or catheter. Any undue discomfort during the procedure must be communicated to the anaesthesiologist immediately.

5. Rarely during removal of the epidural catheter it can be sheared off with a piece being retained in the epidural space. This may require surgical removal.
6. A few other extremely rare complications have also been documented.

Your Medical Aid Fund may pay only part of, or even none of, the fee for an epidural injection. Feel free to discuss this with the Anaesthesiologist.

I declare that I have read and understand the contents of this Information Sheet and that I have discussed any uncertain aspects with the attending Anaesthesiologist.

I hereby consent to having an epidural injection performed on me / my dependant.

Signed at              Hospital on this the       day of           202 .

Signature (patient/ parent/ guardian)

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Dear         

A lower limb block can be given for one of the following possible reasons:

1. As pain relief after your orthopaedic operation of your hip, upper leg, knee, lower leg, ankle or foot.
2. As anaesthesia for your orthopaedic operation of your hip, leg or foot.

Although the most common method for regional anaesthesia of the lower limb is a spinal or epidural, there is a place for the use of these lower limb blocks. Although they can be technically difficult and may require multiple injections, they are safe and give good post-operative pain relief in the absence of a total sympathectomy. These blocks are administered through an injection in the groin, through or below the buttocks, behind the knee joint or around the ankle depending on the type of lower limb block and if it is administered alone or in combination. The type of lower limb block/s depends on the surgical site and includes the following: femoral nerve or 3-in-1 block, sciatic nerve block, popliteal nerve block or ankle block. This is in general a very safe and effective method of pain relief for the lower extremity. The block is administered by your anaesthesiologist who will explain the technique to you. Mostly this block is done with a nerve stimulator to identify the nerves involved when you are already asleep. The bundle nerves that supply the front part of the leg will mostly be blocked at the groin and the big nerve that supplies the back part, lower leg and foot will mostly be blocked at the buttocks by a dministering local anaesthetic. We sometimes block individual nerves lower down the leg. The block usually lasts for 8-10 hours, but the duration differs for each patient and can be as long as a day. Please ask the anaesthesiologist during the pre-operative visit to clarify any uncertainty you may have.

Anaesthesiologists exercise extreme care in administering lower limb blocks but, as with any medical procedure, complications can occur. The following complications are possible:

Common complications:

1. Motor block: While we intend to block only the pain fibres we inadvertently also block the fibres that control movement. Your leg will most likely feel heavy or lame when you wake up from anaesthesia.

2. Failed block: It is possible that the block fails due to mechanical reasons or local factors like obesity or previous surgery. Therefore the block will provide insufficient pain relief and alternative pain methods will be employed.

Rare complications:

1. Haematoma: Because there are a few large blood vessels in the area, it is possible that one of them can be punctured while performing the block and there is a small chance that a haematoma (blood clot) can be formed. The presence of a venous graft or previous repla ement surgery is a relative contra-indication for a block in the same area.

2. Local discomfort: Sometimes it is necessary to go through some tissue, like that of the buttocks to reach the nerves and this can cause some local disc comfort afterwards but it is of short duration.

Very rare complications:

1. Intravenous administration: There is a small risk that the local anaesthetic can be injected directly into the bloodstream which can lead to convulsions or heart dysrhythmias. Extreme care is exercised to prevent this complication.

2. Sepsis: Although we use an aseptic technique, the possibility of a surface infection or abscess exists.

3. Nerve damage: This is possible through the insertion of the needle but is unlikely with the use of a nerve stimulator.

4. A few other extremely rare complications have also been documented in literature.

I declare that I have read and understood the contents of this information sheet and that I have discussed any uncertain aspects with the attending anaesthesiologist.

I hereby consent to having an upper limb block performed on me / my dependant.

Signed at              Hospital on this the       d ay of           202 .

Signature (patient/ parent/ guardian)

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Peripheral Nerve Blocks for Anaesthesia

As part of your anaesthetic management for your operation, your anaesthetist may suggest using a technique called a “nerve block”. Medication called local anaesthetic is injected around a nerve to the area of your operation, making that part of the body numb. Your anaesthetist will explain the extent of the numbness using the diagram below.

What are the benefits of a nerve block?

Nerve blocks have many benefits including:

• Better pain relief after your surgery, especially in the first few days after surgery
• Less need for strong pain-relieving drugs such as opioids (eg: morphine)
• Fewer opioid-related side effects (e.g. nausea, vomiting, drowsiness, constipation, urinary retention and itching)
• Shorter recovery time after your surgery
• Possibly earlier hospital discharge
• Extremely safe procedure

How will the nerve block be performed?

Your anaesthetist has been trained to perform safe and effective nerve blocks. The nerve block may be performed while you are awake, sedated or under anaesthesia. If you are awake while the block is being performed, you may feel some discomfort as the needle is introduced. Let your anaesthetist know if you have excessive pain or strange feelings shooting through the part of your body being blocked. The block may be performed using:

• nerve stimulator (your muscles will twitch slightly) and/ or
• ultrasound guidance (nerve and needle are visualised, allowing a faster, more comfortable and safer nerve block)

What are the risks of a nerve block?

Common complications

• Bruising (the risk is increased if you are taking any blood thinning medication)
• Failure of block
• Persistent weakness and/ or numbness lasting longer than 24 hours (this may be related to the operation itself or positioning and usually resolves completely within a few weeks)

Less common complications

• Infection (risk is higher if a catheter is left in place)
• Lung collapse (with certain blocks only)
• Damage to surrounding structures such as blood vessels, nerves and muscles
• Shortness of breath (with certain blocks only)
• Numbness of the face, visual disturbance or hoarseness of the voice (with certain blocks only)
• Other block-specific complications which your anaesthetist will discuss with you.

Very Rare complications

• Permanent nerve damage
• Overdose of local anaesthetic, which can lead to seizures or cardiac arrest (for which an antidote is available)

After surgery

A “single shot” block can give pain relief for up to 24 hours. Sometimes a very narrow plastic tube called a “catheter” can be left in place to allow local anaesthetic to be administered continuously for a few days after surgery to assist with pain relief. Whilst your limb is numb, it is important to protect it from extreme hot or cold, pressure or awkward positions which may injure you without your knowledge. If you have weak or numb leg, only walk when there is somebody to assist you to make sure that you do not fall. If your limb is still numb after 72 hours (3 days) contact your anaesthetist or hospital.

As the block starts wearing off, you may feel pins-and-needles in the affected area. Be sure to take some pain medication before the block wears off totally to prevent the pain coming back suddenly. Your anaesthetist will discuss with you what pain medication to take.

Do I need to do anything with the pain catheter?

If you are going to have a catheter, your anaesthetist will explain what to expect and how to manage your catheter in your preoperative consultation. It is important to be careful that the catheter is not pulled out since this may decrease its efficacy. If you notice redness, swelling or pain at the catheter insertion site, please make the ward staff or anaesthetist aware of this immediately since it may indicate the beginning of an infection.

What if I am still in pain?

Occasionally, a nerve block may not take away all of your pain. If your pain is not well controlled, you will be offered alternative pain medication that your doctors have prescribed.

What if I do not want a nerve block?

If you do not want to have a nerve block, you will be informed about your other choices for anaesthesia and pain relief after the operation, as well as their potential side effects.

What if I need more information?

You can get more information at www.sasaweb.com

Your anaesthetist will see you in the pre-anaesthetic consultation. He or she is a highly trained doctor whose primary functions are to ensure your safety and comfort around your operation. If you have any additional questions, you can discuss these during this consultation.

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