Understanding Anesthesia for Your Laparoscopic (Robotic) Hysterectomy
- Jen Overton
- Jun 5, 2025
- 10 min read
If you’re scheduled for a laparoscopic or robotic hysterectomy, you may be focused on addressing health concerns like fibroids, heavy bleeding, or pelvic pain to improve your quality of life. The topic of anesthesia, sometimes discussed only briefly in your surgeon's office until the day of surgery, can bring up questions or even some anxiety. As a nurse anesthetist, I’m here to guide you through what to expect on the day of your laparoscopic hysterectomy, explain why general anesthesia is required for this minimally invasive procedure, and describe how a transversus abdominis plane (TAP) block may help manage pain.
I’ll also address the risk of postoperative nausea and vomiting (PONV), a common concern, and how we may use medications and techniques like total intravenous anesthesia (TIVA) to reduce it. This surgery may be done as an outpatient procedure, meaning you go home the same day, or require a short hospital stay, depending on your health. Let’s walk through the process together to help calm your mind. And for clarity, a robotic hysterectomy is also a type of laparoscopic hysterectomy. The anesthesia considerations and requirements for both procedures is exactly the same.
Why Anesthesia Matters for Your Laparoscopic (Robotic) Hysterectomy
Laparoscopic (or Robotic) hysterectomy involves removing the uterus through small incisions using a camera and specialized instruments, sometimes with the assistance of robotic technology. Because the procedure requires inflating your abdomen with carbon dioxide gas to create space for the surgeon to work, general anesthesia is necessary to keep you fully asleep, relaxed, and pain-free. General anesthesia ensures your abdominal muscles are relaxed, your breathing is controlled, and you remain unaware during the surgery, which typically lasts 1–3 hours.
A transversus abdominis plane (TAP) block is sometimes used to manage pain at the incision sites, reducing discomfort after surgery. Additionally, we take steps to minimize the risk of postoperative nausea (PONV), a side effect some patients experience, using medications and tailored anesthesia techniques like TIVA. This combination supports a comfortable procedure and a smoother recovery, whether you go home the same day or stay in the hospital.
Your Day-of-Surgery Anesthesia Experience
Before Surgery: Meeting Your Anesthesia Team
On the morning of your surgery, you’ll arrive at a hospital or outpatient surgical center and check into the preoperative area. Laparoscopic hysterectomy is often an outpatient procedure, meaning you’ll likely go home the same day if you’re healthy, stable, and have someone to help you at home.
However, if you have other health conditions (like heart or lung issues), a more complex hysterectomy (e.g., involving additional pelvic structures), or need closer monitoring, a hospital stay of 1–2 days may be recommended. Your surgical team will discuss this with you based on your health and surgical plan.
In the preoperative area, you’ll meet your anesthesia provider—a nurse anesthetist like me or an anesthesiologist. We’ll review your medical history, medications, allergies, and any history of nausea with anesthesia, as this helps us tailor your care to reduce PONV. This is your chance to ask questions or share concerns, including about nausea or pain management. If you’re feeling nervous, let us know—we can offer explanation, reassurance, or even a mild sedative to help you relax before heading to the operating room.
Transversus Abdominis Plane (TAP) Block: What to Expect
A TAP block is a regional anesthesia technique sometimes used for laparoscopic hysterectomy to provide targeted pain relief at the abdominal incision sites, reducing discomfort after surgery.
Purpose of the TAP Block
The TAP block numbs the nerves in the abdominal wall, helping reduce pain from the small incisions made during laparoscopic surgery. By providing pain relief for 12–24 hours, the TAP block can decrease the need for stronger pain medications (like opioids), helping you feel more alert and comfortable during recovery. This is especially beneficial for outpatient procedures, as it may support a quicker return home.
The Process
The TAP block may be performed in the preoperative area or in the operating room before or after general anesthesia, using ultrasound for precision:
Positioning: You’ll lie on your back, and we’ll expose the side of your abdomen. If you are not under general anesthesia already, we will administer IV sedation medication to ensure you’re very comfortable and guide you through each step.
Cleaning and Numbing: We clean the skin on your abdomen (near your midsection or lower abdomen) with a cool antiseptic solution. Then, we inject a small amount of local anesthetic to numb the skin, which feels like a quick pinch or sting that fades within seconds.
Ultrasound Guidance: Using an ultrasound wand (painless, like a pregnancy scan), we locate the transversus abdominis muscle layer in your abdominal wall. We then insert a small needle to deliver numbing medication near the nerves that supply sensation to your abdomen. You may feel slight pressure, but it shouldn’t be painful. The process takes about 5–10 minutes per side for bilateral blocks.
What You’ll Feel: If the block is done before general anesthesia, you may notice a warm or numb sensation in your abdomen as it takes effect. If performed while you’re asleep, you’ll wake up with reduced pain at the incision sites. The block may cause temporary weakness in the abdominal muscles, which resolves as it wears off.
If you’re worried about needles or the sensation, let us know—we can distract you with conversation, administer IV medication to help you relax, or possibly perform the block while you’re under general anesthesia.
General Anesthesia: What to Expect
Because laparoscopic (robotic) hysterectomy requires inflating the abdomen with gas and precise control of breathing, general anesthesia is necessary to keep you fully asleep, relaxed, and pain-free during the procedure.
Purpose of General Anesthesia
General anesthesia ensures you’re completely unaware and comfortable during surgery. It relaxes your muscles, allowing the surgeon to work safely while the abdomen is inflated, and enables us to control your breathing with a breathing tube. This keeps you safe and still, which is critical for the laparoscopic approach.
The Process
Getting Started: In the operating room, you’ll lie on a padded table, and we’ll place monitors to track your heart rate, blood pressure, and oxygen levels using noninvasive devices (like sticky patches or a finger clip).
Falling Asleep: We’ll give you oxygen through a gentle mask over your nose and mouth, then administer anesthesia medication through the IV. Within seconds, you’ll drift off to sleep, like taking a nap.
During Surgery: After you fall asleep, we place a breathing tube which helps you breathe safely and allows us to give you the muscle relaxing medicines necessary for the surgery. You won’t feel or remember this step. We monitor you closely, adjusting medications to keep you stable throughout the 1–3-hour procedure.
Waking Up: After surgery, we stop the anesthesia medicine, and you’ll wake up in the recovery room. The breathing tube is removed before you’re fully awake, so you won’t notice it.
What You’ll Feel
When you wake up, you may feel groggy, chilly, or have a dry mouth or sore throat from the breathing tube. The TAP block (if used) will reduce pain at your incision sites, though you may feel some pelvic discomfort, bloating, or shoulder pain from the gas used during surgery. These effects are temporary, and we’ll provide comfort measures like pain relief or anti-nausea medication as needed.
Want to know more about what general anesthesia is like? Click on the image below to read General Anesthesia: The Patient Experience form Start to Finish.
Addressing Postoperative Nausea and Vomiting (PONV)
Postoperative nausea and vomiting (PONV) is a common concern after general anesthesia, particularly for procedures like hysterectomy, and women who have GYN surgery are generally at higher risk due to hormonal factors. PONV can be triggered by anesthesia medications, opioid pain medications, the surgery itself, or the gas used in laparoscopy.
We take several steps to reduce this risk and ensure your recovery is as comfortable as possible.
Medications to Prevent Nausea
We use a combination of anti-nausea medications, often given through your IV before or during surgery, to prevent PONV. Common medications include:
Ondansetron (Zofran): A widely used drug that blocks nausea signals in the brain, often given at the start and end of surgery.
Dexamethasone: A steroid that reduces inflammation and nausea, typically administered early in the procedure.
Scopolamine Patch: For patients with a history of severe nausea, a small patch placed behind your ear before surgery can help prevent PONV for up to 24 hours.
Haldol- A small amount can be given IV while you're sleeping and this helps with nausea when you're waking up.
Emend- This anti-nausea medication may be administered prior to rolling back for the surgery, but it helps for nausea after the procedure.
Metoclopramide: Another option used in specific cases to enhance nausea control.
We’ll assess your risk factors for PONV (e.g., history of motion sickness, previous nausea with anesthesia, or smoking status) and tailor the medication plan to your needs. If you experience nausea in the recovery room, we can quickly provide additional medications to relieve it.
Total Intravenous Anesthesia (TIVA)
To further reduce the risk of PONV, we may use total intravenous anesthesia (TIVA) instead of or in combination with inhaled anesthesia gases. TIVA involves delivering all of the anesthesia medications through your IV (using drugs like propofol) rather than using inhaled anesthesia gases, which are more likely to trigger nausea in some patients.
TIVA provides the same level of deep anesthesia required for laparoscopic hysterectomy but is associated with a lower incidence of PONV, helping you wake up feeling clearer and more comfortable. We’ll discuss whether TIVA is suitable for you based on your medical history and nausea risk.
Other Strategies
Minimizing Opioids: Since opioids can contribute to nausea, the TAP block and non-opioid pain relievers (like acetaminophen or NSAIDs like ibuprofen or celebrex) help reduce the need for opioids, lowering PONV risk.
Hydration: We provide IV fluids during surgery to keep you hydrated, which can help prevent nausea.
Gentle Recovery: We avoid sudden movements and ensure a calm wake-up process to minimize nausea triggers.
If you have a history of PONV or are concerned about nausea, let us know during the preoperative discussion—we can prioritize strategies like TIVA and anti-nausea medications to keep you comfortable. We want what's best for you!
Recovery: Outpatient or Inpatient
After surgery, you’ll spend 1–2 hours in the recovery room, where nurses monitor you as you wake up fully. The TAP block (if used) will keep your abdomen numb for several hours, helping with pain control. You may feel pelvic discomfort, bloating, or shoulder pain from the laparoscopic gas. These are all common feelings after this surgery, and we can manage these with medications. If nausea occurs, we’ll promptly treat it with anti-nausea drugs.
If you’re having outpatient surgery—common for healthy patients with good home support—you’ll go home the same day once you’re stable, can move with assistance, and have a ride home. We’ll provide instructions for pain management (e.g., acetaminophen, NSAIDs, or a short-term prescription), activity restrictions (like avoiding heavy lifting), and guidance on diet and recovery to support healing.
If a hospital stay is needed (1–2 days), typically for patients with other health conditions, a more complex hysterectomy, or if additional monitoring is required, you’ll receive IV pain medications, anti-nausea support, and assistance with early mobility. Your anesthesia and surgical teams will ensure you’re prepared for either scenario.
Why This Combination Works
General anesthesia is always required for laparoscopic hysterectomy to keep you safe and comfortable, ensuring muscle relaxation and controlled breathing during the procedure. The TAP block can enhance this by providing targeted pain relief at the incision sites, reducing the need for opioids, which can contribute to nausea. Anti-nausea medications and techniques like TIVA further minimize PONV, supporting a smoother, faster recovery. This combination is ideal for outpatient surgery, allowing you to return home the same day with minimal discomfort, but it also supports inpatient recovery if needed.
Alternative Anesthesia Options
General Anesthesia Alone: If a TAP block isn’t suitable (e.g., due to specific medical conditions or anatomical factors), general anesthesia alone can provide complete comfort during surgery, with pain managed afterward using oral or IV medications.
Local Anesthesia at Incision Sites: The surgeon may inject local anesthetic at the incision sites instead of or in addition to a TAP block to reduce postoperative pain.
Standard Inhaled Anesthesia: If TIVA isn’t used, standard general anesthesia with inhaled gases can still be effective, combined with robust anti-nausea medications to manage PONV.
Share any preferences or concerns (e.g., about nausea, pain, or recovery) with your anesthesia team. We’ll work with you and your surgeon to create a plan that feels right.
Tips to Prepare and Reduce Anxiety
Feeling prepared can ease your nerves and set you up for a smooth surgery. Here are some tips:
Ask Questions: Write down any concerns about anesthesia, nausea, pain, or recovery and ask them during your preoperative visit or on the day of surgery. No question is too small.
Share Nausea History: Tell us if you’ve had nausea with anesthesia before or get motion sickness, so we can tailor your care with TIVA or extra anti-nausea medications.
Practice Relaxation: If you’re anxious, try slow, deep breathing or visualization techniques. We can guide you through relaxation strategies if needed.
Plan for Recovery: Arrange for someone to drive you home (especially for outpatient surgery) and help with tasks for a few days. Have a comfortable recovery space ready, as recommended by your surgeon.
Trust Your Team: Your anesthesia and surgical teams are dedicated to your safety and comfort. We’ll monitor you closely and adjust care to meet your needs, especially to prevent nausea.
Want to learn about how you can help keep yourself as safe as possible during surgery? Click on the image below to read How Can I Keep Myself Safe Under Anesthesia?
Final Thoughts
Anesthesia for your laparoscopic (robotic) hysterectomy is designed to keep you pain-free and relaxed, allowing your surgeon to perform the procedure safely while you focus on a quick recovery. By understanding the need for general anesthesia, the role of the TAP block, and our efforts to reduce postoperative nausea with medications and options like TIVA, as well as whether you’ll recover outpatient or inpatient, you can approach your surgery with confidence and peace of mind.
Your anesthesia team is here to support you every step of the way, ensuring a safe and comfortable experience as you begin your journey to better health.
As your surgery approaches, feel free to reread this article and use it as a tool to prepare your mind for surgery day. Sometimes getting those big feelings out of the way ahead of time can help you focus on healing when it really matters.
If you have more questions or want to learn about anesthesia for other procedures, explore this website or talk to your healthcare team. We’re here to help you feel prepared and at ease because prepared patients have better outcomes!
Considering plastic surgery? Click on the image below to read How Can I Know That My Plastic Surgeon Is Safe? (Plastic Surgery Safety)
Want to learn more about anesthesia for different surgical procedures? Click on the worryfreeanesthesia.com icon below to see a list of Articles.
**Information provided is intended as general healthcare information for the public and should be used as a guide. This information should not be substituted for the specific personal advice recommended by your own healthcare team who are familiar with your specific health history.*
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