Anaesthetics and pain management

The perioperative medicine department provides cover for every major surgical specialty represented in the Trust. In addition, we provide essential services to patients visiting radiology, radiotherapy, cardiology, MRI and medical oncology.

We also run preoperative assessment services, to ensure that our patients are medically and psychologically prepared for surgery.

We offer the full range of anaesthesia and pain management services in areas including:

  • Day and short stay surgery
  • Intensive care
  • Obstetric care
  • Operating theatres
  • Pain management
  • Preoperative assessment

Our mission is to change lives – to give patients the best possible care so that they can live better, fuller, longer lives.

Our world renowned hospitals have made, and continue to make, an outstanding contribution to modern medicine.

For patients

Your anaesthetist will advise you on what anaesthetic techniques will give you greatest benefit for the least amount of risk. Making these decisions is difficult, but your anaesthetist will want to help you so that you can make the choices that are right for you.

Please be reassured that your anaesthetist has undergone rigorous training and assessment to ensure that your anaesthetic is as safe as possible.

Types of anaesthetic

What is an anaesthetic?

The word ‘anaesthesia’ means loss of sensation. An anaesthetic is a treatment that prevents you from feeling pain. Anaesthetics work by blocking the signals that pass along your nerves to your brain. Not all anaesthesia makes you unconscious.

There are three types of anaesthetic these are:

Local anaesthetic

A local anaesthetic numbs a small part of your body immediately surrounding the site of your operation. This is achieved by injecting a drug directly into the surrounding skin. These anaesthetics are often used while you are awake. For example, local anaesthetics are used to numb your skin before you have a cut stitched. The local anaesthetic will gradually wear off after your operation.

Regional anaesthetic

A regional anaesthetic numbs the part of your body, which is being operated on – for example, your arm. This is achieved by injecting a drug around the larger nerves in that body part or region. These anaesthetics are often used while you are awake. The most common regional anaesthetics are spinal and epidural anaesthetics, which are used for operations in the lower half of your body. The regional anaesthetic will gradually wear off after your operation. The type and place of your local or regional anaesthetic injection will depend on the operation you are having.

General anaesthetic

A general anaesthetic makes you unconscious and unaware, more commonly known as ‘sending you off to sleep’. This is achieved by injecting anaesthetic drugs into a vein in your arm or hand, by you breathing in anaesthetic gases or a combination of both. Your anaesthetist will let you know before he/she administers your general anaesthetic. Once started, you will quickly become light headed and then unconscious. Once you are unconscious, your anaesthetist will continue to administer anaesthetic drugs or gases so that you remain asleep and will carefully monitor you throughout the procedure. Once your operation is over, your general anaesthetic will be stopped and you will quickly regain consciousness.

Your anaesthetic

Each type of anaesthetic has its own advantages and disadvantages. Often combinations of local, regional and general anaesthetics are used to tailor your anaesthetic to your needs. Your anaesthetist will discuss with you which type and combinations of anaesthetic are best for you.

The role of your anaesthetist

Your anaesthetist is a doctor with specialist training in the use of anaesthetics, pain management and the care of patients.

Your anaesthetist is responsible for assessing that you are fit enough to be given an anaesthetic, planning which type of anaesthetic is best for you, giving you your anaesthetic, ensuring that you are safe throughout your operation and looking after you whilst you recover from your anaesthetic.

Along with your surgeon, your anaesthetist works closely with other hospital staff to look after you. These include the operating department staff who prepare and maintain equipment and assist in the operating theatre, and the recovery room staff who will care for you after your operation until you are ready to go back to the ward.

Before your operation

Before your operation there are a number of things you can do to better prepare yourself for your anaesthetic:

Stop smoking

Smoking can affect your breathing during your anaesthetic. You should stop smoking for as long as possible prior to your operation.

Lose some weight

Being overweight can increase the risks of your anaesthetic. By losing weight you will reduce some of these risks.

Improve your fitness

Your anaesthetic can be a real work out for your body. If you are fit, your body will find it easier to deal with the anaesthetic.

Nil by mouth

You should receive clear instructions from your doctor about how long you should not eat or drink prior to your operation. Please be aware if you do not follow this advice, your operation may be cancelled. It can be dangerous to have any food or drink in your stomach before your operation.

Keep your medical team informed

Inform your anaesthetist if you have any condition or are taking any medication that means you bruise or bleed more easily. Medications such as aspirin, clopidogrel and warfarin can do this.

If you have not received clear instructions about stopping eating or drinking before your operation, or are unsure about anything, please contact your hospital doctor for further advice.

Pre-assessment clinic

Before your operation we need to make sure that you are fit enough to undergo surgery. We will give you an appointment to come to the pre-operative assessment clinic two to three weeks before your operation. It is important for you to attend this appointment otherwise your operation will most likely be cancelled.

At your appointment, you will see a senior nurse who will ask you a number of questions about your health and lifestyle, and examine you. You will also be weighed, your urine checked, and a pregnancy test may be done. You may undergo routine tests such as a chest x-ray, blood tests and an electro-cardiogram, where small pads are placed on your chest and a tracing of your heart is made.

Some of your medications may need to be stopped before your operation. Please bring any medications that you are taking to your pre-operative assessment clinic. We will then let you know what you need to do. If you are still unsure, please contact the hospital for further advice.

If you feel unwell in the two weeks before your operation please contact your doctor at the hospital. It is important that you are as well as possible before your operation. Depending on the illness and how urgent the surgery is, your operation may need to be postponed until you are better.

On the day of your operation

Meeting your anaesthetist

You will meet your anaesthetist before your operation. Your anaesthetist will make every effort to meet you on the ward before your surgery, but this is not always possible.

Assessing that you are fit enough

Before your operation, your anaesthetist will ask you questions about your health. These will include questions about how you feel now, questions about any past or current illnesses, if you have any loose or capped teeth, any regular medications and any allergies. Your anaesthetist may also examine your mouth, heart and lungs.

Planning your anaesthetic

Your anaesthetist will discuss with you what anaesthetics are available to you and the advantages and disadvantages of each. Together you will decide on your anaesthetic. The best option for you will depend on your operation, your health, your preferences and your anaesthetist’s opinion.

Before your operation

This can vary, but in general, you will change into a hospital gown and be taken to a room outside the operating theatre, known as the anaesthetic room.

The anaesthetic room

Here you will meet your anaesthetist and theatre staff. They will check your identification bracelet, your name and date of birth, and will ask you about other details in your medical records as a final check before your operation. You will be connected to some monitors that check your breathing, heartbeat and blood pressure. Sticky patches will be placed on your chest, a blood-pressure cuff will be placed on your arm and a clip will be placed on your finger. The monitors will bleep in time with your heartbeat and a cuff will inflate on your arm to take your blood pressure regularly. Depending on your operation more monitoring equipment may be attached.

Your anaesthetic

A small needle may be placed in a vein in your arm or hand to help give you your anaesthetic and you may be given an oxygen mask to breathe through. Once you are ready, your anaesthetist will give your anaesthetic and you will be taken into the operating theatre.

During your operation

Your anaesthetist will remain with you throughout your operation to ensure that you are kept safe and comfortable.

After your operation

Your anaesthetist will take you to a recovery room. Here a team of recovery nurses will look after you until you are well enough to be taken to a ward.

Side effects and complications

Please be aware that any anaesthetic can have side effects and complications, but with modern techniques and drugs these are very rare. This is one of the many reasons why a large number of procedures can be done as day cases.

Rare complications to all types of anaesthetic include eye damage, serious allergy to drugs, nerve damage, equipment failure and death. There are probably about five deaths for every million anaesthetics in the UK.

General anaesthetic

Side effects include feeling sick and vomiting, sore throat, dizziness, headache, itching, pain during the injection of drugs, and confusion.

Uncommon side effects and complications include chest infections, bladder problems, damage to teeth, lips or tongue and awareness (becoming conscious during your operation).

Regional anaesthetic

Commonly occurring side effects include pain during the injection of drugs, headache, dizziness, bruising and soreness, and aches and pains.

Uncommon side effects and complications include bladder problems and slow breathing. Please ask your anaesthetist about potential side effects and complications related to your anaesthetic.

Further information and useful contacts

If you want to know more about a particular drug being used for your anaesthetic, then please ask a member of staff. We can discuss any concerns that you may have, and show you any relevant drug information leaflets that have been produced by the manufacturers.

You can also download publications from The Royal College of Anesthetists’ website.

Useful organisations

Royal College of Anaesthetists
This organisation is responsible for standards in anaesthesia, critical care and pain management throughout the UK.

Churchill House
35 Red Lion Square 
London, WC1R 4SG

Tel: 020 7092 1500 
Fax: 020 7092 1730

Association of Anaesthetists of Great Britain and Ireland
This organisation works to promote the development of anaesthesia and the welfare of anaesthetists and their patients in Great Britain and Ireland.

21 Portland Place
London, WC1B 1PY

Tel: 020 7631 1650 
Fax: 020 7631 4352

The Obstetric Anaesthetists’ Association
This organisation works to promote the highest standards of anaesthetic practice in the care of mother and baby. The website provides further information on anaesthesia and pain-relief in childbirth, including films, information cards and patient leaflets.

PO Box 3219
London, SW13 9XR

Tel: 020 8741 1311 
Fax: 020 8741 0611

For clinicians

Our 14 operating theatres are equipped to the highest of standards and include specially designed theatres for orthopaedics, eye surgery, obstetrics and day surgery. We have a history of excellence and innovation having been national pioneers of laparoscopic (keyhole) surgery since the 1980s.

Currently our surgical specialities include general and colorectal surgery, urology, maxillofacial surgery, obstetric and gynaecological surgery, ear nose and throat surgery, eye surgery, orthopaedics and trauma surgery. We have a dedicated 24/7 emergency theatre and a dedicated trauma theatre seven days per week.

As well as our surgeons and anaesthetists we have a multidisciplinary team of over 140 nurses and allied health professionals. We aim to:

  • Provide a safe environment for patients, before, during and after their operation
  • Provide a friendly and caring environment
  • Maintain the patient’s dignity at all times
  • Ensure complete patient confidentiality at all times
  • Ensure that all staff continually update their professional knowledge and deliver a high standard of care.

We provide a comprehensive health check for all patients undergoing an elective surgical procedure. All patients require this assessment prior to their surgery.

We have recently purchased a state of the art specialist exercise testing machine which we will soon use to assess the fitness of selected patients who are due to undergo major surgery. This will help us to ensure that these patients get the best possible care before, during and after their surgery.


If you are a GP or other referring clinician and wish to refer a patient to services at Barts Health, please visit the how to refer section of our website for more information.

Requests for advice and guidance can be submitted via choose and book. A clinician will respond within three working days.

Awake upper limb surgery