No need for a General Anaesthetic for most Hand and Wrist Surgery

For many years a number of hand operations have been done under local anaesthetic, where the surgeon injects the local anaesthetic into the area being operated on to numb it. Carpal tunnel and trigger finger releases and most surgery on the fingers is done this way.

Historically for more major hand and wrist surgery patients would have a general anaesthetic, but over the last few years, anaesthetists have become increasingly skilled at doing regional blocks. This involves injecting long acting local anaesthetic around the nerves in the top of the arm under ultrasound guidance, so that the whole arm goes numb for a few hours. This allows me to do my surgery without the patient feeling anything, but the patient can remain awake, avoiding a general anaesthetic. This has the advantages of patients not feeling groggy or sick for a while, which can occur after a general anaesthetic. They can eat and drink immediately after their operation, can leave the hospital almost straight after their surgery and the block provides very good post-operative pain relief for several hours.

We did a small survey of patients who had had their surgery under an awake regional block recently, and of 21 patients we asked, 100% were satisfied with the experience although one would have liked some sedation during the procedure. The mean time to needing post-operative analgesia was 12 hours, and none of the patients needed strong opiate analgesics.

Most patients are a bit apprehensive beforehand which is understandable, but once the procedure starts they are usually completely happy, and if they are feeling a bit anxious the anaesthetist can give some sedation. Patients can’t see what I’m doing, but if anyone wants to look they can. This is most often the case when I am doing keyhole surgery on the wrist, where I am working from images on a screen which the patient can also watch if they are interested.

If you have a problem with your hand or wrist which you are putting off having treated because of concerns about having a general anaesthetic, then it’s usually possible to have the surgery done under an awake regional block.

Mr JAMES EDWARD NICHOLL

Consultant Orthopaedic Hand, Wrist and Elbow surgery MBBS FRCS (Tr.& Orth.)