Anaesthesia and general information

A guide for patients and relatives.

Introduction

These pages explain what you  may experience if a local anaesthetic is used for your eye operation. It gives a step-by-step guide to what to expect, before, during and after your eye operation.

Southampton is a leading centre for eye surgery under local anaesthesia. Most eye surgery here, is performed this way and much of what we have learned is in this document.

What is local anaesthesia?

Local anaesthetics are drugs that numb nerves and stop you feeling pain. They can be given either as eye drops or injections. Once you have been given a local anaesthetic you will still be awake and aware of what is happening but the aim is that you feel no pain during the operation.

What are the advantages of local anaesthesia?

Local anaesthesia gives excellent conditions for surgery and also offers pain relief after the operation. It usually has fewer risks and side effects than a general anaesthetic, especially if you are elderly. This is because it doesn’t affect the rest of your body, such as your heart or your lungs. People recover more quickly following surgery under local anaesthetic, and can go home on the same day. You can continue to take any prescribed medicine you are on and can eat and drink as normal after the operation.

Do I have a choice?

Yes. Nothing will happen to you until you understand and agree with what has been planned for you.

If you have a preference for a general anaesthetic, you should discuss this with your surgeon in advance. However, there may be a medical reason why you should not have a general anaesthetic.

How is the local anaesthetic given?

There are two types of local anaesthetics

  1. Eye drops – anaesthetic eye drops which numb the surface of the eye. These are given by your anaesthetist or theatre nurse. This is usually painless.
  2. Local anaesthetic injection – an injection around the eye (not into the eyeball) given by your anaesthetist through an extremely fine needle.

This injection is necessary for certain operations such as surgery on the retina and for operations where your eye needs to be completely still during the operation. Sometimes it is recommended for people who may find it difficult to keep their eye still, those who have difficulty when putting drops in or those who have had many previous eye operations.

Is the local anaesthetic injection painful?

This varies between individuals. Before the injection anaesthetic eye drops are given to numb front of the eye. Then an extremely fine needle is used to inject the local anaesthetic around the eye. This local anaesthetic numbs the back of the eye. You usually do not feel the needle but there may be a feeling of  stinging or pressure which should last less than a minute. Your eye will then go numb and the muscles that move the eye will not work as well so the eye will remain still during the operation.

Are there complications of local anaesthetic injections?

Eye surgery under local anaesthesia is safe. Sometimes, however, you may develop bruising or a black eye as the injection may hit a blood vessel around the eye. This is usually not serious but can look unsightly for a week or so. If bleeding is more severe, your operation may be postponed, but this is very uncommon

Serious complications are rare.

Although rare, serious complications such as damage to the eye, reaction to the anaesthetic or spread of local anaesthetic drugs to other areas of the body are known to occur. These complications are difficult to predict. The anaesthetist will be able to give more detail if you wish.

Is there anyone who can’t have a local anaesthetic?

Yes. You will need to be able to lie reasonably flat and still for up to an hour (depending on what operation you are having) and to follow simple instructions.

Local anaesthetic may not be suitable if you

  • cannot lie reasonably flat
  • have an illness that makes it difficult to keep still or a cough you cannot control
  • will have marked difficulty understanding what is being said
  • have a known allergy to local anaesthetic drugs

Pre-Assessment

Once the operation date is planned you should be sent a short questionnaire about your health. You will be asked about general health and fitness, current medication and allergies, medical problems including heart and lung disease and diabetes.

We will also ask about your home situation to make sure you have enough support after the operation.

The day of the operation

For procedures under general anaesthetic or sedation you should receive instructions about eating, drinking and what medication to take on the day of surgery.

For local anaesthetic procedures you will be able to eat and drink as normal before you come into hospital.

  • You should continue to take most prescribed medication as normal including on the day of your operation.
  • If you are taking aspirin or warfarin, please check with the hospital about whether you need to stop these medicines before your operation.
  • If you are diabetic, take your normal medication on the day of the operation with food. We will check your blood sugar levels in the hospital.

On the day of your operation, please bring with you to the hospital any medication you are taking, so the doctors and nurses can check them

In the Day Unit

After you arrive, you will be seen by your eye surgeon who will discuss the operation fully with you. They will then place a mark above the eye that is being operated on. You should then sign your consent form. Your anaesthetist will explain the anaesthetic to you.

You will be asked to wait in the Day Unit until it is the time to have your operation. It is often not easy to predict exactly what time your operation will be and you may have to wait for a while as other patients may need to be seen before surgery starts.

If you have anything to bring with you that will help to pass the time please do so. As there is limited space, we suggest that no more than one person accompanies you if possible.

The ward nurses will usually give you some eye drops to dilate your pupil (make your pupil bigger). These may make your vision slightly blurred.

It is sensible to go to the toilet before you come to theatre so that you can lie still comfortably. Please wear comfortable clothing that is loose around your neck.

The ward nurse will walk the short distance to theatre with you or take you in a wheelchair.

Can I have something to help relax me?

Sedatives can sometimes make you confused and less co-operative and they can slow your breathing.  We therefore do not usually give sedatives unless really necessary. We aim to provide a relaxing, calm environment in the eye theatres. Your anaesthetist and staff in the theatre are used to helping people relax will talk to you and explain what they are going to do.

What happens in the operating theatre?

You will come and lie on the operating trolley in your normal clothes and shoes. The nurse will check you are lying comfortably and that your head is supported in a special pillow. Another pillow is placed under your knees to help make it more comfortable for your back. You will be offered a blanket to keep you warm if you wish.

Staff will ask you to confirm your name and check your consent form.

To monitor you during your operation, your anaesthetist may attach a clip to your finger to measure the oxygen level in your blood and your pulse rate. Your anaesthetist may put a cannula into the vein in the back of your hand in case we need to give you any medication.

Local anaesthetic eye drops that numb the surface of the eye will be applied. If a local anaesthetic injection is required, the anaesthetist will then perform the injections then gently massage the tissues around your eye to help the local anaesthetic to spread evenly.

How do I know that the anaesthetic is working?

Your doctor will check your eye to make sure it is numb. If you have had an injection you may be asked to look in different directions to check how much your eye is moving. Once your anaesthetist is sure that the anaesthetic has worked well your operation can start.

The operation

First you will feel the area around your eye being cleaned with an antiseptic fluid. A sterile surgical sheet will be placed over your face to keep the area around your eye clean. This sheet will have a hole in it to allow the surgeon to operate on your eye and will be lifted off your mouth and nose and rested on a support to make a small tent around your face. A tube will blow fresh air and oxygen around your face to help you breathe easily during the operation.

What if I blink?

A small clip will keep your eyelids open so you do not need to worry about blinking.

During the operation you may feel a few drops of liquid running down the side of your face.  This is quite normal as the surgeon uses a salt-water solution to keep your eye moist.

What will I see?

When the operation starts you will see a bright light from the operating microscope. If you have had only the anaesthetic drops it is important that you look straight at this light and do not move your eye by looking around. If you have had the local anaesthetic injection then this will keep your eye still.

The surgeon operates with special fine instruments, which can reach inside your eye – your eye is not moved from its normal position. You will be aware that the surgeon is working and may often feel pressure sensations. If at any time you feel anything that you think is painful, let the surgeon know and they will be able to give some more local anaesthetic.

Can I speak during the operation?

If the surgeon asks you a question it is fine to answer. Otherwise it is best not to speak unless it is something important as this will make your face move and could affect the surgery. Do not suck sweets or cough lozenges or chew gum.

You will also need to keep the rest of your body as still as possible during the operation – even moving your legs can make your head move slightly.

During the operation it is good for you to try and relax. We often play relaxing music in the theatre. If you wish someone can hold your hand during the operation.

Will I see anything?

It is not unusual to see some lights and movements during the operation and this varies amongst patients. You will not be able to see the operation.

Can I wear my hearing aid during the operation?

We recommend that you remove the hearing aid in the ear on the same side as the operation because sometimes water may trickle into the ear and the hearing aid may start to make noises.

How long does the anaesthetic last?

Usually 2-3 hours, although it can last up to 4 hours. Your eye will be covered with a pad or shield until the following day to protect it and stop you from rubbing it in your asleep.

After a local anaesthetic injection you may experience double vision for a while and so the eye may be padded to prevent this.

A nurse will escort you back to the ward in a wheelchair.

When can I go home?

Once you have recovered and your transport arrives, you may go home once all the medicines that you need to take home have arrived.

You should be given written instructions about recovering from your operation and will be told about any medication you need to take. You will be shown how to put your eye drops in if you are unsure what to do. Drops are used following surgery to reduce inflammation and to prevent infection. You should be given an appointment to attend the ward or the outpatient clinic for a further check up.

Will I be in pain?

You may feel some discomfort when the anaesthetic wears off and you may need to take a painkiller such as paracetamol. It is advisable if you can have someone to help you at home and stay with you for the first night following surgery. If you experience severe pain contact your GP or the hospital immediately.

When can I drive?

You will need to ask the surgeon how long you should wait before driving, as each case is different.

Do I need to take any special care?

You will receive individual instructions about the care of your eye, but the following things are important:

  • Avoid rubbing your eye
  • Wear an eye shield when asleep so you can’t rub your eye without knowing it.
  • Avoid very heavy lifting, strenuous exercise and swimming until you get the all clear from the hospital.