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Obstetric and gynaecological surgery can be divided into the following types:

1. that performed inside your abdomen.
   a) as an open procedure
   b) as a laparoscopic procedure
2. perineal procedures
3. obstetric procedures

The type of anaesthesia and postoperative pain management is different for each of these. The following is general information only and should not be considered to be appropriate to your own situation. You must discuss your situation with your own anaesthetist.

Most patients are only concerned with those details of their anaesthetic of which they will be aware. Aspects including monitoring of heart and lung function, blood pressure and temperature maintenance, management of the level of consciousness and intraoperative prevention of deep venous thrombosis will not be discussed.

Before entering the operating theatre patients may be given sedation if facilities permit. This is usually given into a vein (intravenous) in the anaesthetic waiting room while the patient is still on their trolley. Once in the theatre the anaesthetic is induced. This usually involves another intravenous injection. In some circumstances the induction may be inhalational with anaesthetic vapour.

Induction of general anaesthesia for a Caesarean section however is not usually preceded by sedation because the agents can cross the placenta and depress the baby’s ability to respond and breath when born. Oxygen is usually given to patients before induction, the bed tilted to the left and light pressure applied to the front of the neck to minimize the chance of stomach contents entering the lungs. In addition and antacid may be given before entering the theatre.

Caesarean section is more commonly performed today under spinal or epidural anaesthetic. In this situation the mother remains awake and aware of what is going on, sees their baby being born, but should not feel significant pain. Also the baby’s father can be present in the operating theatre to witness the birth. You should discuss the relative value of general anaesthesia and epidural anaesthesia with your anaesthetist. The details can be quite involved and your choice is an individual one. The choice (all other things being equal) is one for yourself, your anaesthetist and your obstetrician to resolve in your best interests.

Laparoscopic procedures are usually associated with some degree of post-operative abdominal discomfort. This post operative pain may be referred to you shoulder because of the way the nerve supply to the area is arranged. The pain should be expected to be short term and, if you are going home on the same day, to respond to oral agents such as codeine and tramadol. Complicated operative laparoscopic procedures may require stronger agents such as a narcotic and a longer stay in hospital.

Laparoscopic procedures are associated with a higher incidence of postoperative nausea than most other procedures. Your anaesthetist will take special steps to minimise this side effect. If you have suffered from postoperative nausea in the past then you should make sure that your anaesthetist is aware of it.

Finally, this information is of a most general nature only and might not apply directly to you. Nothing replaces a discussion with your anaesthetist as to your particular situation and how he or she intends to deal with it.

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