Common but relatively minor side effects
You can expect some bruising from your intraveinous cannula or arterial line (if required), as well as from your surgery. Sometimes your lips may also sustain bruising from placing your breathing tube.
Sometimes you may have a sore throat after the surgery from where your breathing tube was placed. This typically lasts less than 24 hours.
Nausea or vomiting
Some people wake up from anaesthesia feeling sick, and sometimes vomit. Anaesthetic agents wear off a lot more quickly than those we used 30 years ago, and anti-sickness medications have come a long way in the last 20 years, but some people still feel unwell afterwards. People at higher risk are people having certain types of surgery (particularly abdominal surgery), people who have been sick after anaesthesia in the past, people having longer surgery or more painful surgery, people who get severe motion sickness, younger people, and females.
Almost all surgery causes pain. Pain can usually be adequately controlled with a combination of analgesic medications, often including opioids (medications related to morphine). Sometimes severe pain can be predicted and special techniques can be used, such as spinal anaesthesia, local anaesthetic nerve blocks, post-operative epidural analgesia, or ketamine infusions. Sometimes people have more pain than expected, or are more resistant to analgesics than usual, and it may be a while before their pain is adequately controlled.
Depending on the surgery, one may also experience pain in body areas not operated on, such as shoulders, elbows, neck, back, or chest (if the surgery is performed face-down, for example back surgery). I always take good care to make sure that your position is as comfortable as possible, but sometimes – particularly after long surgery, people can wake up sore.
After particular surgeries, patients’ often feel swollen in their face, hands, or feet. Surgeries that are more likely to lead to this are laparoscopic surgery, long surgery, or surgery associated with significant blood loss (such as joint replacement surgery). The cause is “fluid shifts”, and often I need to give your body extra fluid as fluid leaves the circulation to enter your tissues during the surgery. Over days this fluid will re-enter the circulation again and everything will go back to normal, but in the interim you may be a bit “puffy”.
This is why for some surgeries I ask you to remove any rings. Otherwise, in the worst case scenario, we may have to remove a finger!
I have been surprised to find that feeling drowsy or not being able to concentrate after an operation is some people’s biggest complaint.
Young people have good circulation and lots of muscle mass compared with elderly people, and they absorb a lot more anaesthetic drug into their body, even after relatively short surgery. Often they are surprised to find how long it takes for their concentration to come back to normal.
As a general rule, even after short surgery, expect not to be able to achieve anything for the rest of the day.
Similar to drowsiness, this is sometimes people’s biggest complaint.
Sleep cycles are complicated and nobody really knows how they work, and sometimes an anaesthetic is enough to throw somebody’s sleep cycle out of order. It may take days, or occasionally even weeks for the sleep cycle to recover.
Many people feel itchy after an anaesthetic. This may be a side-effect of spinal anaesthesia or a side-effect of opioid analgesia, but some people who do not have either of these still feel itchy.
It is usually a minor itch in the nose, face, hair-line, chest, abdomen, the inside of the elbows or the back of the knees. Usually people notice it if prompted but it doesn’t really bother them.
Rarely it can be very annoying, and if this is the case I can prescribe medication which may help.
Confusion or delerium.
Many people can experience confusion and disorientation immediately after their anaesthetic, and some people (particularly the elderly) can experience “delerium” after the operation. Delerium may last for some days. Delerium is a fluctuating level of orientation – sometimes the patient may be alert and orientated with good concentration; later they may be drowsy and not really “with it”; and later still they may be agitated or frightened and not really “with it”.
Epidural, spinal, or nerve block failure.
Sometimes I have a fantastic plan to optimally manage your situation, but it just doesn’t work.
I would estimate that 20% of labour epidurals don’t give my patient the complete pain-free experience that we hope that it gives them. Usually they have a lot less pain after the epidural than before it, but it isn’t perfect. (The other 80% are).
I would estimate that 3-4% of my spinal anaesthetics don’t work well enough to perform the operation. This is not a disaster – we can always convert it to a general anaesthetic, but it may cause some anxiety and even some pain as we discover that it is not adequate.
For some surgeries I would usually perform a local anaesthetic nerve block, usually in conjunction with general or spinal anaesthesia. Failure rates have declined a lot in the last 6-8 years as ultrasounds have become more widespread and used for nerve blocks, but sometimes my nerve block appears to be in the perfect position, but my patient still wakes up with pain. I would estimate that this would also happen 3-4% of the time.