General vs spinal vs local anaesthesia: which one will I have, and is spinal safe?

General anaesthetic: fully asleep

Medicine is given through a drip in your hand or arm, or as a gas through a mask, and you go to sleep within moments. A tube or mask helps you breathe while the anaesthetist watches your heart, oxygen and blood pressure the whole time. When the operation ends, the medicines are stopped and you wake up in the recovery area.

It is used for longer or bigger operations, operations in the chest or upper abdomen, and for most children. Common, short-lived effects are a sore throat, feeling sick, shivering and drowsiness. You must not drive or be left alone for at least 24 hours afterwards.

Spinal anaesthetic: awake, numb from the waist down

You sit or lie on your side and a thin needle places local anaesthetic into the fluid around the nerves in your lower back. Within minutes your legs feel warm, heavy and then numb. You feel no pain, but may feel pressure or movement. A screen hides the operation, and you can have sedation to make you drowsy if you prefer.

Spinal anaesthesia is common for caesarean sections, hip and knee replacements, prostate surgery, hernia repair and many operations below the belly button. It avoids a breathing tube, and many people feel more alert and eat sooner afterwards. The numbness usually wears off over a few hours.

• A headache that is worse when sitting up happens occasionally and is treatable
• Some soreness where the needle went in is common and settles
• Difficulty passing urine for a short time can happen
• Lasting nerve damage is rare

Local anaesthetic: only the area is numbed

An injection numbs the skin and tissue around the operation. You are fully awake and can go home soon after. It is used for removing lumps, moles and lipomas, carpal tunnel release, some eye operations including most cataract operations, and many small procedures. The injection stings for a few seconds, then the area goes numb. A nerve block is a bigger version, numbing a whole arm or leg.

Sedation: the in-between

Sedation is medicine that makes you relaxed and drowsy, sometimes enough that you remember little. It is often added to a local or spinal anaesthetic. It is not the same as being asleep under general anaesthetic, but you still need someone to take you home and stay with you.

Myths about spinal injections

Many Nigerians have heard that a spinal injection causes lifelong back pain or paralysis. Long-term back pain is common in adults whether or not they have had a spinal, and studies have not shown that the injection itself causes it. Serious nerve injury is rare. If you are worried, say so: your anaesthetist will explain the options and you can choose a general anaesthetic where it is safe to do so.

You still need to fast for a spinal or sedation, because the plan can change to a general anaesthetic if needed.

Common questions