Anaesthesiology, Intensive Care and Pain Medicine Department

  • About
  • Anaesthesiology
    FAQs
  • Post Operative Acute
    Pain FAQs
  • PACE Clinic

We provide anaesthestic services to 18 elective and 3 emergency operating theatres (OT) in TTSH.

Each OT is manned by an anaesthetic specialist. A team of doctors headed by an anaesthetic specialist is available round the clock, 7 days a week to cater to the anaesthesia requirements of patients needing emergency operations.

We also provide ad-hoc off-site anaesthesia in the neuroradiology, endocentre, diagnostic radiology and NHG 1 Health at Ang Mo Kio. Over 20,000 anaesthetics are administered yearly.

Our services include:

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Anaesthesia helps you to be comfortable during surgery or a procedure. It will remove pain and sensation.

The benefits of anaesthesia need to be weighed against the risks and this balance will vary from person to person depending on the operation and their general health.

What are the different types of Anaesthesia?

There are many types of anaesthesia. The type of anaesthesia you may have depends on your medical condition and the type of surgery. Your anaesthetist will advise you on the appropriate type of anaesthesia after discussion with you and the surgical team.

Types of Anaesthesia Remarks
Anaesthesia In a general anaesthetic, a mixture of drugs is given to keep you unconscious and pain free during the operation.

In a general anaesthetic, a mixture of drugs is given to keep you unconscious and pain free during the operation. Drugs are injected into the blood stream via a vein or breathed in as gases or vapours into the lungs.

A device may be placed in your throat or windpipe to help you breathe when you are asleep. The device is removed when you wake up after surgery.
Regional Regional anaesthesia involves injecting local anaesthetics to numb the region to be operated. No pain is felt during surgery although it is possible you may feel pressure or movements.

Common types of regional anaesthesia include spinal and epidural anaesthesia where a needle is inserted between the bones of the spine to inject a small amount of local anaesthetic in the space or fluid surrounding the spinal cord. These techniques can also be used for postoperative pain relief.

Other parts of the body such as the arm can also be safely anaesthetised by injecting local anaesthetics into the appropriate region. The effect of the local anaesthetic is temporary. You may also be given drugs to make you feel relaxed and drowsy during the procedure.
Local Local anaesthesia refers to temporarily numbing the area to be operated on by injecting local anaesthetic into the skin. This is usually performed for minor procedures such as stitching of cuts.

Monitored Anaesthetic Care (MAC) – Local anaesthesia is injected by the surgeon to numb the operative area and mild sedation is provided for by the anesthetist

What are some of the benefits and risks of regional Anaesthesia?

The benefits of regional anaesthesia include excellent pain relief after surgery, less nausea and vomiting and early return to drinking and eating after surgery.

Headache is an infrequent complication of spinal or epidural anaesthesia. It is usually temporary but may be severe and last several days.

Nerve damage due to infection, bleeding or other causes is a rare complication. This may cause weakness and numbness of the body part that the nerve supplies.

Will I be conscious during the surgery?

Before the operation you and your anaesthetist can decide whether you remain fully awake during the operation or prefer to be sedated so that you are not so aware of the whole process. The amount of sedation can be adjusted so that you are aware but not anxious. Local or regional anaesthesia may be combined with general anaesthesia.

Are there any risks from Anaesthesia?

All anaesthesia has some risks and these depend on many factors such as co-existing medical conditions and the type of surgery. Anaesthesia risks can be thought of in terms of side effects and complications.

Side effects are sometimes unavoidable but generally temporary. Complications are unexpected and unwanted effects due to a treatment and can be serious.

Common Temporary Side – Effects

  • Nausea and vomiting
  • Sore throat
  • Pain or bruising at injection sites
  • Dizziness
  • Blurred vision
  • Shivering

Infrequent Complications

  • Muscle pains
  • Headaches
  • Allergic reactions
  • Temporary breathing difficulties
  • Damage to teeth, dental prosthesis
  • Damage to voice box which may cause temporary loss of voice
  • Damage to nerves and pressures areas
  • Chest infection
  • An existing medical condition getting worse e.g. stroke, heart attack

Extremely Rare and Serious Complications

  • Severe allergic reactions
  • Permanent nerve damage
  • Damage to eyes
  • Awareness under general anaesthesia
  • Brain damage

When are my risks for anaesthesia increased?

The following factors will increase your risks:

  • Presence of coexisting illness such as hypertension, heart disease, diabetes, kidney disease, chronic lung disease
  • Obesity
  • Smoking
  • Long operations
  • Emergency operations

Do I have a choice of anaesthetic?

Yes. Your anaesthetist will assess your preference and advise you on the most appropriate choice of anaesthesia. It is usually possible to accommodate individual patients’ wishes.

What are my responsibilities?

Anaesthesia is very safe. There are some risks and possible complications. Most complications can be prevented. Good communication is important. Make sure you inform your doctor of all your medical conditions, medications, allergies and previous anaesthetic experience.

It is important that you follow the instructions to help you prepare for surgery such as medications to take or to avoid and how long to fast (NO FOOD OR DRINK) before surgery.

WHAT IS ACUTE PAIN?

Acute pain is pain which lasts for a short period (few days to few weeks) . It is usually the result of injury to the body for example a skin wound, a broken bone, or a surgical operation.

HOW MUCH PAIN WILL I FEEL AFTER MY OPERATION?

Very minimal if at all. It depends on: –

1. Your personal pain threshold: Some patients have higher thresholds and feel less pain. You can let your anaesthetist know of your personal pain threshold based on your previous experience with injuries or operations.
2. The type of operation: This will not only affect how much pain you feel, but also how long you feel that pain. Your anaesthetist will speak to you regarding pain management options for your operation before your surgery.

HOW WILL YOU KNOW HOW MUCH PAIN I AM FEELING?

Your nurses and doctors will assess the amount of pain you are feeling in a few standardized ways –

  1. By asking you to grade your pain on a scale of 0 – 10, with 0 representing no pain and 10 representing the worst pain you have ever felt. if you find this very difficult, they may also ask you to grade your pain according to whether it is mild, moderate, or severe.
  2. By looking at your heart rate, blood pressure, and breathing rate.
  3. By observing how well you are able to take deep breaths, cough, and move around. This may include asking you to move the affected body part, sit up in bed, or even walk around. your nurses and doctors are trained to assist you during this assessment so as to minimize the amount of pain or discomfort that you feel

HOW MUCH DO I HAVE TO PAY FOR PAIN MANAGEMENT?

It varies with the option chosen. Our costs are very competitive and include not just the equipment and the the medication used, but also the visits that our nurse and anaesthetist will make after your operation to ensure your pain is well managed. Your anaesthetist will be more than happy to discuss the cost of various techniques.

WHY SHOULD I BE TREATED FOR ACUTE PAIN?

Most patients want to avoid pain if possible, and we want to treat it as well as we can.

Untreated acute pain often leads to anxiety, insomnia, and sometimes even a total loss of function. Research also shows that pain has many other less obvious undesirable consequences, such as increasing the risk of irregular heartbeat, heart attack, breathing difficulty, poor intestinal movement, decreased immunity, and an excessive tendency for blood to clot. All these may lead to complications, increased hospital stay, and even death.

HOW WILL I BE TREATED FOR ACUTE PAIN?

All patients will receive painkillers before and throughout the operation. Post-operative pain management options are:

  1. Swallowed painkillers like panadol, non steroidal anti-inflammatory drugs (NSAIDs) such as brufen, ponstan, synflex, voltaren, arcoxia, or celebrex and opioids such as tramadol and oxycodone. Side effects are rare, and the benefits of decreased pain far outweigh the side effects of painkillers.
  2. Side effects:  
    Panadol drug allergy, liver impairment, and kidney impairment.
    NSAIDs drug allergy, aggravation of asthma, gastritis, liver impairment, and kidney impairment.
    Opioids drowsiness, nausea, vomiting, constipation, and itching.
  3. Injected painkillers like opioids such as tramadol, fentanyl, morphine, or oxycodone, and an injectable type ofNSAID called toradol.
  4. Patient controlled analgesia (PCA) – where a pump containing an opioid is connected to your iv cannula. This delivers a fixed dose of medication when pressed.  It allows you to control the amount of painkiller you receive, and therefore control the amount of pain you feel. There is a lockout built in so you cannot overdose yourself.
  5. Spinal – where a very fine needle is inserted into the spinal canal. Local anaesthetic is injected through the needle and acts on the spinal nerves to produce loss of pain sensation and strength in the lower half of the body. Usually used for operations on the lower half of the body. Side effects are uncommon and include headache, bleeding at the injection site, and nerve injury. The risk of paralysis is extremely rare.
  6. Epidural -  where a needle is inserted into the epidural space just around the spinal canal. Local anaesthetic may be injected through the needle, or a thin tube may be placed in the space, after which local anaesthetic is injected through it. The epidural works in almost the same way as the spinal. Side effects are also similar to those for the spinal option.
  7. Nerve block –where a needle is inserted into the space around the nerve that supplies the part of the body to be operated on; can be the arm, the leg, or even the abdomen. Ultrasound guidance is often used to ensure that the needle is in the right location. Nerve stimulation may also be used to confirm that the needle is in the right location. You may feel painless twitches of your muscles during the nerve stimulation. Local anaesthetic is injected through the needle and acts on the nerve to produce loss of pain sensation and strength in the affected body part. Side effects are uncommon and include bleeding at the injection site, injury to surrounding structures, and nerve injury. The risk of paralysis (like the spinal option) is extremely rare.

WHAT IF I DON’T LIKE SWALLOWING TABLETS?

Besides tablets, swallowed painkillers also come in liquid form, which may be easier for you.

WHAT IF I DON’T LIKE INJECTIONS?

A plastic tube called an iv cannula is usually painlessly inserted into your hand before the operation. most injected painkillers are then given through this cannula with minimal discomfort.

Pain management options like the spinal, epidural, and nerve block usually require an additional injection before the operation, for safety reasons. your anaesthetist will usually give you painkillers and medication to help you relax before the additional injection is performed.

PANADOL? I CAN GET IT OVER THE COUNTER AND CHEAP! WHY DO I HAVE TO TAKE IT AFTER AN OPERATION?

Panadol is widely available and cheap. However, research also shows that it is an effective painkiller when taken in combination with other stronger painkillers. In our experience, we find that prescribing panadol together with other stronger painkillers is often very effective in treating mild to moderate pain often reducing the amount of stronger medication needed.

WHY AM I BEING GIVEN SO MANY DIFFERENT PAINKILLERS AT ONE TIME?

You are probably being treated for moderate to severe pain. Research has shown that painkillers are more effective and have less side effects when combined with other painkillers

I DON’T LIKE OPIOIDS. I THINK I WILL GET ADDICTED TO THEM.

Though opioids can be addictive, there is no evidence that using opioids to treat acute pain leads to addiction. You will be reviewed frequently by your doctors if you are on opioids, and the opioids will be stopped when you no longer require them. There is therefore minimal risk of addiction.

I HAVE MOTION SICKNESS AND PREVIOUS BAD EXPERIENCES WITH OPIOIDS.

Please inform your anaesthetist of the above. Your experience may be due to a particular opioid, in which case a different opioid may be substituted with satisfactory results. or a repeat of your bad experience may be avoided by prescribing prophylactic (preventive) medication together with the opioid.

WHAT IF IM ALLERGIC TO PAINKILLERS?

As can be seen above, there are many pain management options available. It is extremely rare that a patient is allergic to all the painkillers that we have available.

WHAT IF I SUFFER FROM SIDE EFFECTS OF THE PAINKILLERS?

You will be reviewed regularly by your surgeon, by the pain nurse and anaesthetist. They will assess whether your symptoms are due to the painkillers and advise you accordingly.

WHAT IF I SUFFER FROM COMPLICATIONS OF THE PAIN MANAGEMENT OPTIONS?

The risk of complications from your chosen pain management option is usually very low. Even so, you will be reviewed regularly by your pain nurse and anaesthetist. In the unlikely event that complications occur, your pain nurse and anaesthetist will give you the best possible treatment to minimize your chance of a permanent injury.

I AM NOT FEELING ANY PAIN NOW. WHY SHOULD I TAKE THE MEDICATION?

It is likely that if you stop taking the medications you will start feeling pain. Most patients would rather not feel any pain at all, than to feel pain before starting painkillers. Besides, they also work to reduce inflammation and swelling, contributing to a faster recovery from surgery.

WHAT IF MY TREATMENT DOES NOT WORK?

It is very rare that the pain management option you have chosen does not work. If it does not, your anaesthetist will work extra hard to ensure that you suffer minimal pain and discomfort and that the cause of failure is addressed and/ or a new alternative is offered

HOW OFTEN WILL I BE SEEN?

You will be seen daily by the Acute Pain Service team. They will ensure that your pain continues to be well managed and that any side effects or complications are picked up and addressed in a timely manner.

WHAT IF I NEED TREATMENT AT 9PM? WILL THERE ALSO BE SOMEONE TO TREAT MY PAIN AT 2AM IN THE MORNING?

There is 24 hour ward coverage provided by the anaesthetist on duty. Your nurse or doctor knows when to refer issues regarding your pain management option to the anaesthetist on duty.

WHAT IF MY PAIN LASTS MUCH LONGER THAN EXPECTED?

In some instances, acute pain may become chronic pain. It is important, then, to find out the source of the pain, and why it is lasting for so long.Your doctor will contact the anaesthetist on duty for advice and everything will be done to minimize the pain and suffering you have to endure.

Pre-admission Assessment, Counselling
and Evaluation
(PACE) consultation determines whether your body’s health condition can withstand the stress of a surgery. You will obtain information on the benefit of the surgery and its associated risk to help you make an informed decision regarding the anaesthetic and the operation.

We will then schedule a date for the surgery and give you pre-operative instructions and payment options.

Who will make the appointment for me at the PACE clinic?

Your Surgical Specialist Outpatient Clinic (SOC) will make the PACE appointment for you. It may be scheduled on the same day as your SOC visit, or on another day.

When do I have to go to the PACE clinic?

You will be advised to go to the PACE Clinic 2 days to 2 months (usually 1 month) before your surgery.

What should I take with me?

  1. You should bring :
    • Authorisation form for Admission
    • Specialist Outpatient Appointment card
    • Identity Card.
  2. You should bring your medical reports and current medications.
  3. If you are a foreign worker covered by your company's insurance policy, you are requested to give us your company's Letter of Guarantee before the surgery, by hand, mail or fax. If you intend to ask your insurance company to pay, you are advised to contact your insurance company for the level of coverage provided in your policy.

What will happen in the PACE clinic?

We will take your medical history, conduct a physical examination and trace your old health records. You may need to undergo blood tests and radiographic imaging (X-Rays). There is no need to wait for the test results but we may need to recall you if abnormal results are detected and further tests are required.

If your medical condition is poorly controlled, a consultation with our specialists in the Medical SOC may have to be arranged on another day for further investigation.

You will be given verbal and written advice on anaesthetic and medical risk as part of the informed consent for surgery. Please feel free ask us more about anaesthesia and post-operative pain management.

We will give you a date of surgery and pre-operative instructions. You will get an early date if your surgical condition is life-threatening and your medical conditions are well controlled. A day or two before the surgery, you will receive a call from us, reiterating the pre-operative instructions.

We will present you with the payment options based on the level of subsidy desired, and the amount claimable from your Medisave and personal health insurance.

How long will it take?

The PACE visit takes 2 hours on average. If you have opted for an appointment, your waiting time will be shorter than if you have opted to walk in.

The 1st hour (on average) is for scheduling surgery date and financial counseling.

The 2nd hour (on average) is for clinical consultation. Major surgery and poorly controlled medical problems result in a longer consult.

Who will see me? Will I get to see the Anesthesiologist who will anesthetise me for my operation?

You will be attended to by a trained clinician who is guided by our hospital’s strict protocols for pre-operative assessment and management. Poorly controlled medical problems and planned major surgery will be attended to by a doctor.

You will only see your anaesthesiologist when you are admitted for surgery. You may make your enquiries on anaesthesia in PACE or when you see your anaesthesiologist in the operation room.

You will be attended to by a trained staff for scheduling, pre-operative instructions and financial counselling.

Can I request for a particular anesthesiologist?

Yes. You may make the request and we will try to accede. However we cannot quarantee that your request will be acceded to.

What are the fees for this PACE consultation?

It is $25 (plus GST) for non-subsidised patients and $15 for subsidised patients. Subsidised patients may enjoy further reduction depending on the level of subsidy.

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