Having an anaesthetic for your shoulder or elbow procedure?
All you need to know

You may be having a shoulder or elbow operation for a fracture, tendon or ligament injury/tear, replacement operation or any other elective procedure (keyhole or open technique).
 Having an operation can be a stressful experience. This is designed to give you some basic information and help you prepare for an anaesthetic for your surgery.

On the day of your operation
Nothing to eat or drink – fasting (‘Nil by mouth’) The hospital should have given you clear instructions about fasting. It is important to follow these.

  • If you are a smoker you should not smoke on the day of your operation.
  • This will help avoid breathing problems during your anaesthetic.
  • If you are taking medicines, you should continue to take them as usual, unless your nurse, anaesthetist or surgeon has asked you not to.
  • If you feel unwell when you are due to come into hospital, please telephone the ward for advice.

Your Anaesthetic options

You may be aware of a number of different anaesthetic options that can be used for this type of surgery.

  • A nerve block where you stay awake (with or without sedation).
  • A nerve block with general anaesthetic.
  • A general anaesthetic (being fully asleep)

The anesthetist will see you before your surgery on the day and you will have an opportunity to discuss what is best suited for you. The anaesthetic procedure will proceed only after you understand and agree with what has been planned for you. This document gives you basic information about these choices. You can find more information on the website www.youranaesthetic.info. If you have any questions please discuss this in detail with your anaesthetist / surgeon who will be more than happy to address your queries.

A Nerve Block – also called a regional block
This is an injection of local anaesthetic medication in your neck that ‘blocks’ the nerves that go to your shoulder and upper limb numbing them for many hours afterwards. You will not be able to move your arm properly during this time. You may also ask for some sedation to help you relax before a block.
A nerve block is carried out in the anaesthetic room. A plastic cannula is inserted into a vein on your hand to enable us to give you fluids and medications. You are connected to routine monitoring equipment during the procedure. After cleaning the side of your neck with an antiseptic and injecting local anaesthetic to numb the skin, the nerve block is performed. A needle is guided by your anaesthetist with the help of an ultrasound machine to inject the local anaesthetic drug around nerves in your neck area. Ultrasound makes the whole process a lot safer and more effective.

The block generally starts to work within 5 minutes and the surgeon will check and ensure that it is completely effective before commencing the surgery. You may feel some sensation of tugging and pressure but there should not be any sharp pain. The nerve block usually lasts between 4-12 hours (depending on the kind of local anaesthetic injected).

A General anaesthetic
This produces a state of controlled unconsciousness during which you feel nothing. You will receive anaesthetic medications, strong painkillers (like morphine), oxygen and sometimes a medicine to relax your muscles. You will also need a breathing tube in your throat whilst you are asleep so the oxygen and anaesthetic gases can move easily to your lungs. When the operation is finished, the anaesthetic is stopped and you regain consciousness.

Is it essential for me to have a block?
It is your choice that is made after a discussion with your anaesthetist. There are several alternative methods of pain relief using morphine that work well; injections given by the nurses or by a pump connected to the plastic tube in the vein which you control by pressing a button (Patient Controlled Analgesia, ‘PCA’). You will also be able to take pain-relieving tablets by mouth. We usually manage to make people comfortable postoperatively but we are more successful when we use a nerve block.

We routinely undertake a majority of our shoulder and elbow operations under a nerve block and have an excellent team of expert anaesthetists who specialize in nerve block procedures.

Advantages of being awake during surgery

  • Since you are already awake, you do not have to worry about ‘waking up’ during or after surgery. You will also avoid the common potential side effects and complications of a general anaesthetic like sore throat, nausea/vomiting, being drowsy, and rare complications like stroke.
  • Your recovery is likely to be faster. If you have a heart or a breathing condition, avoiding a general anaesthetic is much safer. You can eat and drink as soon as the operation is over and go home earlier.
  • You may watch the procedure on a television screen and ask questions about the problems with your shoulder. If you choose not to watch, you can have a little sedation to make you feel more relaxed.
  • If for some reason during the surgery you feel that you would rather be asleep, you could ask your anaesthetist and still have a general anaesthetic (being asleep).
  • Having a procedure under a block facilitates ‘day case surgery’.

 

Side effects
Modern anaesthetics are very safe and serious side effects are uncommon. Despite this the risks cannot be completely removed. Following are some of the side effects and potential complications associated with both techniques.

What should I expect when I get home?
In order to maximise your pain relief, please take regular pain killers as prescribed, before your block wears off (while your arm is still numb.)
You should keep your arm in the sling provided, making sure your sensation and movements have returned before you attempt to use your arm normally again. The surgeon will tell you if you need to wear the sling any longer.

Take extreme care moving your arm when it is numb. You should do slow cautious movements avoiding awkward positions and over extension of your joints.
When your arm is numb you will be unable to feel heat or cold properly so keep your arm away from constant pressure, radiators/fires/hot water/extremes of cold.
The normal signs that tell would you that this type of anaesthetic is wearing off could include: Tingling – like pins and needles, increased sensation and movement of the affected part and discomfort or pain.

Written by Dr Navneet Narula, Consultant Anaesthetist; Dr Alexander Philip, Senior Anaesthetic Registrar; Mr Amol Tambe, Consultant Shoulder and Elbow Surgeon.