Local anaesthesia
- Dr Ahmed Almaki, Consultant Anaesthetist
Local anaesthesia is when a part of your body is numbed with a medicine called a local anaesthetic. You may have a local anaesthetic to stop pain during and after surgery. Or you may use a local anaesthetic to treat a painful condition such as a sore throat.
How does a local anaesthetic work?
A local anaesthetic works by blocking the way your nerves carry pain signals to your brain. This numbing effect lasts for a short while. You’re still awake and aware of what’s going on around you, but you can’t feel any pain. You usually just feel some touch and pressure sensations instead.
When would I have a local anaesthetic?
You may have a local anaesthetic before you have:
- a needle put in your skin if you’re having an injection or a blood test
- a tube (called a cannula) put into a vein on the back of your hand before surgery
- dental treatment – for example, having a tooth taken out
- a minor procedure – this could be anything from a gastroscopy to having a skin lesion removed
- an eye operation – for example, having a cataract removed
You may also use a local anaesthetic to treat a painful condition such as:
- a sore throat
- haemorrhoids (piles)
- mouth ulcers
- sore nipples when you’re breastfeeding
Regional anaesthesia is a type of local anaesthesia that you may have to:
- numb a specific part of your body, such as your pelvis or legs, before an operation
- ease pain during labour and childbirth (an epidural or spinal anaesthetic)
Sometimes, you may have a combination of different types of anaesthesia. For example, you may have an operation under general anaesthesia, then a local or regional anaesthetic to ease pain afterwards.
Types of local anaesthesia
There are three main types of local anaesthesia:
- topical anaesthesia
- local anaesthetic injections
- regional anaesthesia
Topical anaesthesia
This is when you have a local anaesthetic put on your skin. It may be in the form of a gel or cream, drops, an ointment or a spray. It may be used to numb the area before you have an injection or implant, so you don’t feel pain from the needle.
Local anaesthetic injections
A local anaesthetic can be injected just under your skin to target the nerves that make you feel pain. Your skin and the area just below it will feel numb afterwards. You may have this before a minor surgical procedure.
Regional anaesthesia
For regional anaesthesia, your doctor or anaesthetist will inject a local anaesthetic near a nerve. This is to numb a large area or an area deep inside your body. There are three types of regional anaesthesia.
Spinal anaesthetics
A spinal anaesthetic is injected into the fluid around your spinal cord to numb your legs and the area below your belly button. This may be used before some types of surgery – for example, a hip replacement.
Epidural anaesthetics
You have an epidural anaesthetic through a small tube that’s put into your back. The anaesthetic can be topped up through the tube as you need it to ease any pain. Epidural anaesthesia can focus on a specific part of your body such as your bladder, and can be used before a Caesarean section. It can also be used for surgery and pain relief, and lower back and leg pain.
Nerve block
If you have a nerve block, the local anaesthetic is injected into the tissues around a particular nerve. This blocks the sensation to an area such as your hand, leg or head before you have a surgical procedure.
How an epidural is given
What is an epidural? | the procedure - watch in 1 minute 37 seconds
An epidural is an injection into your lower back to temporarily block pain from your waist down. This video describes how an epidural is given.
An epidural is an injection into your lower back that temporarily blocks pain from your waist down.
You'll be asked either to lie on your side with your knees tucked into your chest, or to sit upright and lean forward.
This opens up the space between the bones in your spine.
Your anaesthetist will carry out your epidural in two parts.
Firstly, a small amount of local anaesthetic is injected into your skin to completely numb the area.
Then, a hollow epidural needle is given into your epidural space.
This is the space just outside the membranes that surround your spinal cord.
When the epidural needle reaches the correct spot, your anaesthetist will thread a very thin plastic tube through the centre of the hollow needle.
They'll then remove the epidural needle, leaving just the tube in place.
The tube will run from inside your epidural space to the outside of your body.
It's secured using adhesive tape and used by your anaesthetist to give you medicines for pain relief when you need them.
Your anaesthetist may also attach a pump to the tube so you can top up your pain relief when needed, and sometimes you'll be able to control this yourself.
When you no longer need pain relief, the tube will be carefully removed and the area covered with a plaster.
Having a local anaesthetic
If you’re having a topical anaesthetic cream before surgery, it’s usually put on your skin in a thick layer. It’s then covered with a dressing, which is taken off just before the procedure (for example, putting a needle in). The cream will usually be put on your skin at least an hour before your surgery, but no more than five hours before.
When you have a local anaesthetic injection, you’ll be asked to stay very still. You may notice a warm, tingly sensation as the local anaesthetic starts working. If you’re having a nerve block, the anaesthetist will use an ultrasound scan or nerve stimulator to make sure the anaesthetic is going to the right nerve.
The healthcare professional giving the local anaesthetic will only start the surgical procedure once they’re sure the anaesthetic is working and you don’t feel any pain. If you’re still feeling pain, it’s important to tell them because they will need to use more anaesthetic.
How long do local anaesthetics take to work?
- Local anaesthetics vary in how quickly they work. Some local anaesthetic injections work after a few minutes. Others may take longer to work, up to around 30 minutes.
- An anaesthetic eye spray can take just a few seconds to work.
- A local anaesthetic cream can take up to 60 minutes to work.
How long do local anaesthetics last?
Some local anaesthetics last for longer than others. So, it’s important to discuss this with your anaesthetist or doctor.
- Local anaesthetic creams may work for up to 90 minutes.
- A local anaesthetic injection may last for up to three hours.
- With an epidural, the numbness can last for a few hours or even a few days. This depends on how much medicine you’re given. You can also top up the anaesthetic so it lasts for longer, which is useful during labour.
- A spinal anaesthetic can make you numb for around two hours.
- If you have a nerve block, the area may stay numb for several hours.
How quickly will I recover from a local anaesthetic?
After local anaesthesia, you may be able to go home on the same day. If you have a sedative, you’ll need to be monitored for a while afterwards but will usually be able to go home on the same day. How quickly you recover will depend on which type of anaesthetic you had.
If you have regional anaesthesia, it will take some hours before you get your feeling back. It’s important to protect the area while you’re still feeling numb, so you don’t hurt yourself. As your feeling returns, you may notice a tingling sensation.
Your doctor may recommend you take painkillers as the local anaesthetic wears off. Ask your anaesthetist or nurse about when you’ll be able to eat and drink afterwards. This will depend on which type of anaesthesia and which surgery or procedure you’ve had.
Driving after local anaesthesia
Whether or not you can drive after local anaesthesia depends on which type of procedure you’ve had. It will also depend on whether or not your anaesthetic will affect how well you can drive.
If you were given a sedative as well as local anaesthetic, wait at least 24 hours before you drive. Ask your doctor for advice. Legally, it’s your responsibility to remain in control of a vehicle at all times. So, if your procedure or anaesthetic affects this in any way, it’s best to wait. You’ll also need to check your car insurance policy.
What are the side-effects of local anaesthesia?
Side-effects of local anaesthesia are unwanted but mostly temporary effects that you may have after having a local anaesthetic.
You may notice a stinging sensation when the local anaesthetic is injected into your skin. You may get a bit of pain when an epidural or spinal anaesthetic is injected. You may also get:
- some redness of your skin – this may be caused by an allergy
- some bruising around the skin where you were given the local anaesthetic
- an infection
- some bleeding at the injection site
With some types of local anaesthetic, you may also get:
- a headache (if you have spinal anaesthesia)
- damage to nerves (if you have regional anaesthesia) – this doesn’t usually last for very long
Most people don’t react badly to local anaesthetics. But you can get a very severe allergic reaction called anaphylaxis. Or you could have problems with your heart and nervous system. Ask your anaesthetist for more information.
What are the alternatives to local anaesthesia?
You may have general anaesthesia instead. This is when you're asleep during the operation. Having general anaesthesia isn’t as safe as local anaesthesia and you may take longer to recover afterwards. But you may prefer to be unconscious during your procedure. You can discuss your options with your anaesthetist or surgeon.
If you’re having dental surgery, you’re more likely to have a general anaesthetic if you:
- are very anxious
- have an infection around the injection site
- are prone to bleeding problems
- are having major surgery
If you don’t want to stay awake for a procedure but are having a local anaesthetic, you may be able to have a sedative. This means you’re in a sleep-like state but won’t be unconscious.
After surgery, you may be able to have other painkilling medicines, such as morphine. You may have morphine into a vein through an intravenous drip which you can control yourself. This is called patient-controlled analgesia (PCA).
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If you have a local anaesthetic, you’ll be awake during the procedure. You shouldn’t feel any pain but may feel some pressure sensations. For more information, see our section: How does a local anaesthetic work?
Local anaesthesia can cause some side-effects. These include redness or bruising at the site of the local anaesthesia. You may get other side-effects such as a headache if you have spinal anaesthesia. For more information, see our section: What are the side-effects of local anaesthesia?
Local anaesthesia uses medicines called local anaesthetics. These drugs block the way nerves carry pain signals to your brain. Local anaesthetics may be put on your skin or injected into your skin. For more information, see our section: Types of local anaesthesia.
Local anaesthesia means you stay awake during the procedure but don’t feel any pain. General anaesthesia means you’re asleep during the procedure. For more information, see our section: What are the alternatives to local anaesthesia?
Whether or not you can drive after local anaesthesia will depend on which procedure you’ve had. It will also depend on how the local anaesthetic has affected you. For more information, see our section: How quickly will I recover from a local anaesthetic?
Some types of local anaesthetic last longer than others. A local anaesthetic cream may last for around 90 minutes. But a local anaesthetic injection may last for several hours. For more information, see our section: Having a local anaesthetic.
General anaesthesia
General anaesthesia is when medication is given to make you temporarily unconscious during an operation, so don't feel pain or other sensations.
Epidurals for surgery and pain relief
An epidural is an injection of a local anaesthetic and/or other pain-relieving medicine into a space that surrounds your spinal cord
Epidural injections for lower back, leg pain
Sometimes spinal injections (epidural or nerve root injections) are used to treat chronic back and leg pain.
Over-the-counter painkillers
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- Victoria Goldman, Freelance Health Editor
