Local anaesthetic with sedation: what to expect

The short answer: with local anaesthetic and conscious sedation, you are awake but deeply relaxed. A sedation doctor gives you a calming medicine through a small tube in your hand or arm and stays with you the whole time. Once you are relaxed, I numb the area, so you should not feel pain. Most people remember very little afterwards. You go home the same day, but you need an adult to take you home and stay with you.

Many people feel nervous before a procedure, and that is completely normal. Sedation is one of the ways we can make the day calmer and more comfortable. This page explains what happens, step by step, so you know exactly what to expect. Please share it with whoever is taking you home, too.

What is conscious sedation?

A sedative medicine is given through a cannula, a tiny plastic tube placed in a vein in the back of your hand or your arm. Putting it in feels like a quick sharp scratch, and the needle is removed straight away, leaving only the soft plastic tube.

The sedative makes you feel relaxed and much less anxious, and perhaps a little drowsy. You stay awake, can talk to us and can follow simple requests, such as turning your head. Our sedation doctor sums it up as “aware, but don’t care”.

The medicine also affects your memory for a while. Later that day, or the next day, it is very common to feel as if you were asleep, because you may remember little or nothing of the procedure. If you do remember anything, it is usually just the last few minutes, as the sedation lightens.

How is it different from a general anaesthetic?

• Sedation: you are awake and breathing for yourself, but relaxed. Recovery is usually quicker and gentler.
• General anaesthetic: you are fully unconscious, and an anaesthetist controls your breathing. It is used for larger operations and usually means a longer recovery.

Sedation does not numb anything on its own. That is the job of the local anaesthetic, which I give once you are relaxed.

Who looks after you?

Your sedation is given by a dedicated sedation doctor, a highly skilled professional whose only job during your procedure is you. They stay with you from start to finish, give exactly the right amount of medicine, monitor you closely and manage any side effects. That leaves me free to concentrate on your procedure.

Throughout, we monitor your breathing, oxygen level, heart rate and blood pressure, using a small clip on your finger and a blood pressure cuff on your arm.

Before the day

When you book, you will be asked to fill in a medical questionnaire. Please complete it fully and honestly, as it helps the sedation doctor plan safe sedation for you. You will also be given written information and a consent form, and you can ask the team anything you are unsure about.

The day and night before:

• eat and drink as usual
• take all your usual medicines, unless you have been told otherwise
• avoid alcohol
• avoid nicotine if you can, or at least cut down
• arrange for a responsible adult to take you home and stay with you afterwards (more on this below)
• try to relax. You are in very good hands.

On the day

• Follow the eating and drinking instructions you have been given for your procedure.
• Take your usual medicines, unless you have been told otherwise. Do not drink alcohol, and try not to smoke.
• Tell the team if anything about your health has changed, or if you feel unwell. It may affect your treatment.
• Come with the adult who will take you home. Please do not bring children with you.

What happens during the procedure

1. Getting comfortable. We check your details, go through your consent form and answer any last questions. You lie or sit comfortably and we attach the monitoring.
2. The cannula. The sedation doctor places the small tube in your hand or arm. A quick sharp scratch, and then it is done.
3. Sedation. The medicine is given gradually until you feel relaxed and calm. Many people describe it as pleasantly drowsy, a little like the moment before you drift off to sleep.
4. Local anaesthetic. Once you are relaxed, I numb the area with local anaesthetic injections. These can sting for a few seconds, but with sedation most people barely notice. After that, you may feel pressure or movement, but you should not feel pain. If you feel anything sharp, just tell us and I will add more local anaesthetic.
5. The procedure. The sedation doctor watches over you throughout and adjusts the medicine as needed. You can talk to us at any time.
6. Waking up gently. Towards the end, the sedation is lightened so that your recovery is smoother.

Recovery and going home

You rest in the clinic for a short while afterwards. How long varies from person to person, so we cannot always give your escort an exact time. You go home only when the sedation doctor is happy that you are safe, and your escort must be there to collect you.

You must travel home by car or taxi with your escort. Please do not walk home or use public transport, even if you feel fine.

The first 24 hours

The sedative stays in your system for a while. You may feel drowsy and unsteady on your feet, a little like after a few drinks, and your judgement and memory can be affected for up to 24 hours. For that reason, for 24 hours after your procedure:

• rest for a few hours once home, and spend the rest of the day quietly. Sit propped up on pillows or cushions rather than lying flat on your back.
• do not drive, ride a bike, or use machines or appliances. That includes the kettle and the cooker.
• do not drink alcohol
• do not look after children or anyone who depends on you until the next day
• do not make important decisions or sign anything important, such as contracts or legal documents
• be careful with social media, emails and messages. It is best to avoid them if you can.
• keep taking your usual medicines, unless you have been told otherwise, and follow the aftercare instructions for your procedure, including which painkillers to take

Is sedation safe?

Serious problems are uncommon with modern sedation, and the sedation doctor is there specifically to spot and deal with anything early. As with any medicine, there can be side effects.

Common, and expected:

• bruising where the cannula was, which fades over a day or two
• your breathing slowing a little and your oxygen level dipping slightly as you relax. This is monitored throughout, and you may simply be asked to take a few deeper breaths.
• a slight fall in blood pressure, which is also monitored throughout
• feeling drowsy and unsteady afterwards
• little or no memory of the procedure, and judgement affected for up to 24 hours

Very uncommon:

• feeling sick or being sick
• a severe allergic reaction

If anything unexpected does happen, the sedation doctor is trained and equipped to treat it straight away.

For the person taking you home

If you are someone’s escort, thank you. Your role really matters. You must be:

• a responsible, able-bodied adult aged 18 or over
• at the clinic to collect them when they are ready to go home. Recovery times vary, so you may need to wait a short while.
• able to take them home by car or taxi
• able to stay with them for at least 6 hours once home, and ideally overnight

Once home, help them get comfortable, propped up on pillows rather than lying flat, and encourage them to rest. Gently remind them not to drive, cook, drink alcohol, look after children, or make big decisions until the next day. You will be asked to sign a short form confirming you have read the escort instructions. If you have any concerns, please call the team.

Quick questions

Will I be asleep?

No. You stay awake and can talk to us, but you feel relaxed and calm. Because of the effect on memory, many people feel afterwards as if they had been asleep.

Will it hurt?

You will feel a sharp scratch when the cannula goes in, and the local anaesthetic can sting for a few seconds. After that, the area is numb. If you feel anything sharp, tell us and I will give more local anaesthetic.

I am very anxious about procedures. Can sedation help?

Yes. This is exactly what it is for. Please tell us at your consultation if you are nervous, so we can talk through whether sedation suits you.

Can I go home on my own in a taxi?

No. An adult must collect you and travel home with you, then stay with you for at least 6 hours. If you cannot arrange this, please tell us before the day, because we cannot go ahead with sedation without an escort.

Which procedures can be done this way?

It depends on the procedure and on you. Smaller procedures are often done with local anaesthetic alone. Sedation can be added for some treatments, such as rhinophyma treatment, facial fat grafting and skin tightening of the face and neck. I will talk through the options for your procedure at your consultation.

Does sedation cost extra?

Sedation has its own fee for the sedation doctor’s care. We will tell you the cost before you book.

Next steps

If you have a question about sedation that is not answered here, please ask. You can call the team on 020 3026 9695 or send us a message, and we will be happy to talk it through.