Ultrasound Guided Brachial Plexus ‘Blocks’ for Arm and Hand Surgery
Most shoulder operations are carried out under a combination of both regional and general anaesthesia. Regional anaesthesia is a nerve block which provides excellent pain relief for shoulder surgery and to do this we perform an injection in the side of your neck (Interscalene nerve block). This injection is done under sedation which means that 50% of our patients have no recollection of the injection and those that do remember it generally do not report it as a painful procedure.
Following the nerve block you will then be given a full general anaesthetic which is administered into a drip we put into the back of your hand. The next thing you know you will be waking up in recovery and with your numb arm in a sling.
Sickness in our patients is very uncommon and so you should wake feeling clear headed and ready for a sandwich and a cup of tea!
The brachial plexus is the group of nerves that lies between your neck and armpit and it contains all the nerves that supply everything from your shoulder to your fingertips.
An injection of local anaesthetic around the brachial plexus will ‘block’ information travelling along the nerves resulting in your arm becoming numb and immobile.
For shoulder surgery we inject local anaesthetic around the nerves between 2 of your Scalene muscles in your neck and this will give you a very numb shoulder, arm and hand, although you may retain sensation down the little finger side of the hand.
The ‘block’ should provide you with excellent pain relief for about 18 hours after the operation (range 8 to 24 hours).
As the ‘block’ wears off you may experience pins and needles in your fingers – this is normal.
Side Effects and Risks
Interscalene blocks can cause a husky voice and a droopy eyelid on the side we are operating on.
You sometime will feel that you cannot take a deep breath in as your diaphragm can get numbed up as well. Should this happen to you then this will wear off as the local anaesthetic wears off (18-24 hours).
Following resolution of the block about 10% patients will notice a prolonged patch of numbness in their arm. This will resolve in 95% of these patients in 4-6 weeks and 99% within a year.
Longer term nerve damage related to the injection occur in about 1:5-10,000 injections.
For more information on the nerve block download this PDF.
The General Anaesthetic
The general anaesthetic is delivered by giving drugs into the drip in the back of your hand.
To help you with your breathing when you are asleep we put a small device into the back of your mouth called a flexible laryngeal mask. This is removed as you wake up but about 15% of patients are left with a slightly sore throat which will get better on it’s own over the next couple of days.
Do you need assistance
You will need to seek help from the emergency services if you notice unexplained breathlessness or severe pain that is not controlled by your tablets.
If the block has not fully worn off by 3-4 days after your operation then please contact Mr Hand's secretary on +44 2380 914 423
Dr Harry Akerman - Consultant Anaesthetists
Dr Akerman has been working with Mr Hand since 2008 in both the NHS and in private practice. He trained as a doctor in London and during his post graduate training he has also worked in Australia, New Zealand and across the South of England. Dr Akerman has been a consultant at University Hospital Southampton since 2008 where he is the lead for regional anaesthesia (injections that numb up parts of your body to give you the best form of pain relief following surgery). His main area of interest is in patient outcomes and he has co-designed software to collate feedback from patients ,thus ensuring he knows better than most how his patients fare following surgery. Dr Akerman regularly teaches regional anaesthesia on national courses and lectures nationally and internationally on patient outcomes.
Away from work Dr Akerman spends his time surrounded by women! Married to Catherine they have 3 girls (and 4 hens!) and when time allows he is a keen sportsman who still plays fives, cricket, tennis and enjoys skiing and cycling. He is also a keen golfer whose main aim for the next year is to get Mr Hand out on the course more often!