Local Anaesthetic and Sedation

The Westbourne Centre is the only private clinic in the UK dedicated to carrying out all surgical procedures under local anaesthetic with or without sedation. Procedures range from facelifts, rhinoplasty and breast augmentations, to hernia repairs and bunion surgery.

Wherever you see this logo it means that the procedure can be carried out under Local Anaesthetic and Sedation

Why do we carry out all our procedures under local anaesthetic with or without sedation?

Our pioneering techniques are driven by our mission to improve patient safety and comfort and revolutionise the recovery process.

A primary concern when planning any type of surgical procedure is the anaesthetic and the prospect of being “completely under”. We receive a significant amount of enquiries from people looking to travel to our clinic because they do not want a general anaesthetic and do not want to stay overnight in hospital.

Our unique ability to perform a wide range of major surgical procedures using local anaesthetic was adopted and developed initially for cosmetic surgery by two consultant surgeons at The Westbourne Centre, Mr Fazel Fatah and Mr Hiroshi Nishikawa, in collaboration with a group of dedicated consultant anaesthetists. Years of auditing and evaluating the technique have demonstrated positive surgical outcomes and an overwhelming acceptance by patients.

Mr Fazel Fatah

Consultant Plastic, Reconstructive and Aesthetic Surgeon

Mr Hiroshi Nishikawa

Consultant Plastic, Reconstructive and Aesthetic Surgeon

What are the main benefits of local anaesthetic (with or without sedation)?

Local anaesthesia stops pain during a medical procedure by blocking pain signals from being carried by nerves to the brain. A person having local anaesthesia will be awake during the procedure, although it can be combined with sedation to lessen the awareness.

This revolutionary technique allows a variety of surgical procedures to be carried out with a quicker recovery time and fewer side effects:

  • Compared to general anaesthetic techniques, the rate of recovery immediately after surgery is faster and more predictable. During surgery, patients breathe on their own and therefore do not require an ‘artificial airway’; because of this there are no post-op sore throats and virtually no incidence of post-operative coughing, which could compromise the results of the surgery or cause post-operative bleeds.

  • As relatively small amounts of sedatives and painkillers are given, this also reduces the risk of post-operative nausea & vomiting, thus further decreasing the potential of post-operative complications.

  • Local anaesthetic administration also means that the post-operative pain is better controlled and the need for very strong post-operative opiate drugs is often unnecessary. As the drugs are so short acting, patients recover from the sedation very quickly.

  • All of above allows early discharge from hospital. As a result, surgery that had previously required an overnight stay because of the effects of general anaesthesia, can now be carried out as day cases.

Our audits have revealed that operating under local anaesthetic with sedation is a very safe technique with high patient satisfaction.

During the procedure, the patient is very carefully monitored, as during any operation. The technique requires skilled and highly trained anaesthetists. Surgical technique has never been compromised and, because the surgery also relies on the efficiency of the local anaesthetic infiltration carried out by the surgeon, we have found that it requires more operative precision and care.

We believe this enhances the overall outcome and results of surgery.

About local anaesthesia

The word 'anaesthesia' comes from a Greek word meaning ‘absence’ or ‘loss of sensation’. Anaesthesia is one of the most significant developments of modern medicine because it allows once unbearable medical procedures to be performed without discomfort. Local anaesthesia completely blocks feeling from the treated area and the patient will stay awake during the procedure. Local anaesthetic drugs produce a numbing effect and can last from two to eight hours.

About sedation

Sedative drugs relieve anxiety and help you to relax without needing to be asleep during the procedure. Patients remember very little about the treatment done under sedation. Sedative drugs don't block the pain signals to the brain, so local or regional anaesthesia is often given as well.

How is local anaesthesia given?

Local anaesthetic in injected into the area being operated on.

As local anaesthetic only numbs a particular area, you will stay awake during the procedure. You will start to lose feeling very quickly in the treated area, but your operation won't start until your clinician or dentist is absolutely sure that the area is numb. It's important to realise that local anaesthesia takes away feelings of pain, but you may still be aware of pressure and movement during your procedure.

How is sedation given?

The sedation is administered straight into the blood stream via a cannula either on the back of your hand or in your arm.

The type and dose of sedative given depends on how anxious the patient is and the type of procedure. The level of sedation can be adjusted according to the needs of the patient. This is made possible by intravenous infusion of highly controlled amounts of painkilling and sedative drugs via infusion pumps. These pumps allow very accurate administration of the required drugs to achieve the right conditions for surgery.

The drugs we use are a combination of Remifentanil (a strong very short-acting opiate) and Propofol. This drug is a powerful sedative, but is also short acting which means it is very quick to leave your system after the surgery. Sedatives can sometimes affect breathing, so while sedated, the anaesthetist will constantly monitor the amount of oxygen in your blood through a small device on your finger, and the patient may be given extra oxygen through a mask or a plastic nasal tube.

What are the risks of local anaesthesia and sedation?

Local anaesthesia and sedation are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of these procedures.

Side-effects of both local anaesthesia and sedation vary depending on which medicine is used.

After local anaesthesia you may get a headache, feel sick or vomit and have feelings similar to those of being drunk or hung over. Some people experience a drop in blood pressure or temporary loss of muscle control. The side-effects of sedation are similar to local anaesthesia. You may also feel confused, you may not remember the operation and you may be tired or light-headed the following day.

Complications of local anaesthesia or sedation include:

  • toxic reactions - signs of a toxic reaction include tingling lips, ringing in the ears, drowsiness and slurred speech, rarely this can lead to an arrhythmia (a disturbance of the normal heartbeat) and heart attack
  • low oxygen levels in the blood - this can cause breathlessness and confusion

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your clinician or dentist to explain how these risks apply to you.

If you experience any of the symptoms mentioned, please contact The Westbourne Centre immediately on 0121 456 0880.

Recovering from local anaesthetic and sedation
What to expect afterwards

After a local anaesthetic it may take several hours before the feeling comes back into the treated area. You must take special care not to bump or knock the area as you may not be aware of any potential injury you may have sustained until the feeling starts to come back. You may need pain relief to help with any discomfort as the anaesthetic wears off, and our theatre team will help you plan your timings for taking this.

After a local anaesthetic or sedation, you will usually be able to go home within a couple hours after surgery. You will need someone to drive you home and you should follow the advice of your clinician and nurse about how much activity you can do. Sedation temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you are in any doubt about driving, please contact your motor insurer so you are aware of their recommendations, and always follow your surgeon's advice.

What do our patients think?

We have found that the vast majority of patients find the process of sedation a pleasant experience and do not recall anything about the operation, unless they have requested that their level of sedation is minimal.

Some patients feel they want to be more in control of their feelings during surgery. With these patients our technique is to increase the level of sedation only during the administration of the local anaesthetic and then to titrate the amount given for the rest of the operation, so that patients can remain awake but pain free if they so wish.

I had my procedure under local with sedation and could not remember a thing throughout. I was able to go home around an hour after to recover at home which was amazing as I just wanted to be in my own environment.
Thank you Westbourne Centre!

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