MINOR PLASTIC SURGERY

 Minor plastic surgery, such as removal of small skin cancers or revising scars, can be performed under either general or local anaesthesia.  If you have local anaesthesia we will also provide you with some sedation, particularly at the time the local anaesthetic is being injected as this is the most uncomfortable part of the procedure.

HAND SURGERY

Hand surgery for procedures such as carpal tunnel, trigger fingers, and Dupuytren's contractures can be performed under either general anaesthesia or local anaesthesia either with or without some sedation. For other procedures, particularly more extensive hand procedures, a regional block may also be used. A regional block involves an injection of local anaesthetic around the nerves supplying the area being operated on. Such blocks are usually carried out using an ultrasound machine to help guide the needle so the local anaesthetic is placed in the correct place and to help reduce the chance of nerve damage. Even using the ultrasound machine there is still a small (5%) chance of the block not working properly and a very small chance of nerve damage. Such damage usually results in a small area that feels funny, numb or different after the block wears off. This area usually gets better slowly over a period of days to weeks. Very rarely this area may not recover fully. After a major block to the nerves at the level of the armpit or the side of your neck your whole arm will be heavy and numb for up to 24 hours afterwards.

BREAST SURGERY

We work with Mr Richard Dickinson  who performs aesthetic and re-constructive surgery on the breast. Both breast augmentation and breast reduction are performed under general anaesthesia. Augmentation is a less time consuming operation and involves less effects on the surrounding tissue. You will have a general anaesthetic combined with a local anaesthetic block, called a paraverterbral block.  This is performed with you sitting on the side of the bed and after numbing the skin with some local anaesthetic we locate a triangular shaped space between your ribs, the large muscles beside your spinal column, and the bones of your spinal column using an ultrasound machine to guide our needle.  We inject local anaesthetic into this space which will numb your chest wall.  We perform this block on each side and most patients find that it is only mildly uncomfortable at worst.  We will give you some mild sedation before we perform this block.  After this you will usually only require pain relief with tablets following the procedure. Most patients are able to go home after an overnight stay in hospital, although some patients having augmentation procedures may be suitable to have their surgery performed as a day procedure.  Breast reduction is a more involved procedure and it is also performed under general anaesthesia accompanied by paravertebral blocks.  After we have seen you pre-operatively we will order you a number of tablets as a pre med. Some of these are likely to make you feel  a little drowsy after your procedure. We continue these tablets post operatively as well, this is usually all you will required, although occassionally you may need stronger pain relief.  If this is required it is in the form of a pain relieving drip.

ABDOMINOPLASTY

Abdominoplasty ("tummy tuck") is a major procedure on both the skin and muscles of the abdominal wall.  After we have seen you pre-operatively we will order you a premed of a number of different drugs.  Some of these are likely to make you feel drowsy after your procedure.  After the procedure is finished, and before you wake up, we will inject local anaesthetic into the muscles of your abdomen and insert small plastic catheters into the space between two of the muscle layers.  We will then connect these catheters to small containers of local anaesthetic (called a "pain pump" or a "pain buster").  These continuously infuse a small amount of local anaesthetic for the next two days to help keep you comfortable after the procedure.  This, along with the same tablets you had for your premed, are usually all you will need for pain relief.  Very occasionally you may require stronger pain relief in the form of a pain relieving drip.