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Dear Doctor,
My doctor has recommended that I have my gynaecological surgery whilst awake, rather than being put to sleep. What is all this about?
Sandra
Dear Sandra,
Performing surgery while patients are awake has many benefits, and is usually recommended whenever appropriate. There are three main categories of anaesthesia; referred to as general, regional and local anaesthesia. Your gynaecologist, in consultation with the anaesthetist will determine the best type of anaesthesia for you, taking your desires into consideration. General anaesthesia involves total loss of consciousness, in contrast to local anaesthesia which numbs only a specific area of the body. Regional anaesthesia numbs a larger part of the body, and includes what is called spinal and epidural blocks, commonly used in gynaecology. Your doctor must have deemed regional anaesthesia suitable for you. You could still be given a sedative to induce light sleep whilst your surgery is being done, or remain fully awake. Either way, the surgery will be pain-free.
What types of procedures can be done under regional anaesthesia while I am awake?
Your doctor will determine that regional anaesthesia is safe for you before recommending it. Caesarean sections, hysterectomies, and many pelvic surgical procedures can all be done under regional anaesthesia. Other non-gynaecological procedures can also be done under regional anaesthesia.
I have heard other women report bad experiences after having Caesareans while awake, is it really safe?
Yes, regional anaesthesia is completely safe. In fact, studies have shown that regional anaesthesia is much safer than general anaesthesia during pregnancy. There is less nausea, and faster awakening if light sedation was used. Regional anaesthesia may be extended to post-operative pain control, thus less need for injectable painkillers which sometimes may interfere with breathing. Your bowel function recovers quicker, and you will find it easier to participate in physical therapy to aid quicker recovery.
Like all medical procedures, there are some risks associated with regional anaesthesia. Most of the risks are rare and minor, and usually unlikely to occur. You might experience some discomfort at the site of the aesthetic injection for a few days. Your blood pressure may decrease during the anaesthesia, but this is easily controlled with fluids. Some women may suffer a headache a few days after the anaesthesia, which may sometimes require review in hospital and specific interventions. The risk of permanent nerve injury or chronic back pain attributable to spinal anaesthesia is rare.
How do I decide then whether to have my surgery done while awake, or should I just opt for general anaesthesia?
Your gynaecologist, together with the anaesthetist will guide you in decision-making. Please ask questions to clarify any unclear issues. You may still be suitable for general anaesthesia if this is what you prefer. All you want at the end of the day is safety and good outcomes with your surgery.
- Dr Alfred Murage is a consultant obstetrician/gynaecologist
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