Sedation and additional pain relief?

[vipersnest1]

I'm having a procedure on Friday and will have sedation. I've already had the same procedure with gas and air only, and it was agony.
I'm worried that it will still be very painful, so am wondering what else I can have on top of the sedation if I need it.
Any experience of this would be helpful, so TIA for reading and hopefully responding.

I had IV sedation to have teeth out. No idea what else they gave me but it was flipping marvellous. Felt like I downed a bottle of wine on a hot day. No memory of the whole thing 😁

I’ve had sedation for a dental procedure in a dental clinic and also for two orthopaedic investigations in an NHS hospital. I was ‘out’ soon after the meds were administered and certainly didn’t feel a thing on each of those occasions, much like a general anaesthetic. I would choose this option again if I had to undergo any similar investigation.
Hope it goes well and please don’t dread it as that is the point of sedation - to be pain free but with a quicker recovery from the anaesthetic.

I've been sedated three times to have needles in my spine. I ask them to do as much as they can. The first time I did feel a bit of pain so I ask for more now. Last time I didn't feel a thing and sedation is lovely!

Sedation is wonderful. I had it a year ago to have a tooth taken out. I was lying there all drowsy and time seemed to be dragging a bit so I asked when they were going to start the procedure. They said we’ve already done it! 😂

After dental surgery last week, infection/complications after and I used paracetamol and ibuprofen only. Had some codeine but didn't need it this time. Didn't dare take anything before the sedation though!

I had midazolam when I had a tooth out and I didn't feel a thing..I think that's what's they normally give in sedation

Thanks @Scotinoz, @MyfavouriteisA, @BryceQuinlanTheFirst, @Twiglets1 and @Idunnowhyibother for the replies.
@BryceQuinlanTheFirst, that is the thing - I'm worrying that I will be given 'just enough' and no more.
I don't care if I'm totally out of it - in fact I'd rather be, and not be able to remember anything, than have awful memories of the procedure like I did last time. (I had to lay in a particular position and couldn't do that for a few days after, at home, because it brought the whole thing back.)
I felt so strongly about it that I wrote a letter to PALS (I used the word barbaric in the letter - it was), so that it doesn't happen to anyone else.

@bellalou1234, I've done a bit of looking around and some hospitals use midazolam, but others use fentanyl.

You need to tell the anethnetist(sp?) about your worry and experience and ask them for lots. You will have the chance to speak while they are setting it up for you.

@BryceQuinlanTheFirst, I will.
I rang today to make sure they would have sedation available as I'm really very anxious about it and don't want to be fobbed off with 'it will be alright'. Last time was enough for me. The procedure is to check for a possible cancer, so obviously I'm worried about that, but the major cause of anxiety is that it will still be horrible and I might have to do something similar in the future.

That's awful I'm so sorry for you. I hope they listen, I'm sure they will

Thank you, @BryceQuinlanTheFirst.

Depends on the procedure and who’s doing the sedation and whether you have any other medical problems. Non-anaesthetist led sedation lists are often quite protocolised for safety reasons. Anaesthetists are more used to managing the side effects of deeper sedation and may use different techniques. Deep sedation is not always appropriate/safe/necessary (for example if the problem is pain rather than recollection then pain relief rather than sedation may be more appropriate). Whoever is doing the sedation should be able to explain things in more detail as part of the consent process before they start.

It sounds to me like you will be having an endoscopy procedure, OP?
If so, there will not be an anaesthetist. The consultant will provide the sedation. In our unit it is midazolam to relax you, and fentanyl for pain relief. I think most units are the same. We allow you to use gas and air too, if needed. There is only so much they can safely give you. You will not be asleep. You will be awake. Some private clinics do offer deeper sedation.
We do understand that for some patients this an an extremely painful procedure. But you may have taken some prep that is quite tough going too, so we do want you to have the procedure and get the ‘all clear’, which is why you’re having it done.
If you really can’t take it, just ask them to stop. There are alternatives (CT of your bowel) which can be done. In some cases they may be able to do it under GA. We do occasional GA lists for patients and some of them just can’t tolerate it under sedation.
Do remember though, that on a different day, you may find it much easier, less traumatic and painful. There is no rhyme or reason to it. We don’t want you to suffer! We don’t enjoy seeing patients so sore, and do all we can to help you get through it.
Obviously it any be something else entirely, but good luck anyway.

@Greybeardy, thank you.
@JollyJunee, it's a flexi sig. And yes, I'm doing movicol. Thank you for trying to reassure me, but last time I felt I was on a conveyor belt and viewed as a nuisance. It took over 30 minutes to give you an idea that my gut wasn't cooperating. The staff did very little to reassure me, in fact, I was spoken to only once the whole time, and that was a nurse feeling me to breathe the gas and air more slowly.

A flex sig should only take 10 mins.
when you take G&A, if you start ‘panting’ or rapid breathing with G&A it won’t work, and can make you feel sick/tingly hands etc.
The best way to use it is long, deep breath…then hold your breath for a second or two…then breathe all the way out.
We don’t generally offer sedation for Flex Sig as it’s so quick, but if someone is very anxious or had a bad experience we would give it no prob.
You can’t drive and need a known adult to take you home and stay with you over night.

@JollyJunee, my neighbour is going to help me out with a lift there and back. Taking slow deep breaths of gas and air did pretty much bugger all for the pain, to be honest.
I have endometriosis (dormant now as I am menopausal, but I never had it removed as back in the day - it was hormonal treatment only). I'm pretty sure I have a lot of scar tissue in my abdomen, due to that plus surgeries for prolapses.
The pain was the worst I've experienced apart from the time when I lost the lining of my gut due to an intolerance of macrolide antibiotics (I genuinely thought I was going to die).

You poor pet. But honestly, we do have patients that really struggle. Just make sure you discuss it with the admitting nurse and consultant when they do your consent. We really don’t want to torture you! But with your history, they cannot make it completely pain free, but will do what they can to make you as comfortable as possible. As I said, it’s only 10 mins…5 really as easier on way out!🤞

@JollyJunee, my fingers are crossed too!
Having said that (and I know I have a high pain threshold usually), I'm still dreading it.
I've also got two tests / investigations tomorrow as well to get through.
You've probably realised that I'm on the two week pathway. Whilst my logical brain is telling me there's only a small chance it could be cancer, my emotional heart is saying there is a chance and it could be me.
I've lost several relatives to cancer over the last couple of years and I have a cousin who is now terminally ill with bowel cancer. (They are younger than me.)
My previous experience, coupled with the knowledge that I could find out something life-changing, has me really rattled.

Aw, that’s a lot to be dealing with. Your concerns and worries are so valid. Please do confide in the staff, they will want to help. X

Teenage DD had midazolam as a pre med before going down for spinal surgery a few months ago - she still talks about how much she loved it🤣 It made her very drowsy and relaxed. In her own words, she knew what was going on around her but just didn’t care about any of it.

@clipclop5, that would be fine by me.

@JollyJunee, I'm just resurrecting this to say that I had midazolam and initially they said I could have entonox as well, but when it came to it, they decided fentanyl was more appropriate. (They stopped while they were doing it, told me to change position and waited until the pain had settled before they continued - this was in stark contrast to my first experience.)
It was loads better and I thanked them for listening to me.
The biggest bonus is that I don't have cancer!

Yay! So glad it was a good experience, and that it was all clear. 🎉

@JollyJunee, where's the like button? 😁