Nerve Blocks for Upper Limb Surgery

Patient Leaflets Team

  • Reference Number: HEY1164/2020
  • Departments: Anaesthetics

Introduction

For almost every operation that is carried out, an anaesthetic is used to achieve anaesthesia.  Anaesthesia means that you will not feel pain and other sensations. Anaesthetics can be given in different ways and you do not always have to be asleep. For surgery on your shoulder, arms and hands, one type of anaesthetic that you can have is called a ‘nerve block’ or regional anaesthesia.

What is a nerve block?

A nerve block means that we inject local anaesthetic around a nerve, which makes part (or all) of the arm numb. We can do many operations with just a nerve block as your anaesthetic. This will be done by your anaesthetist or surgeon.  Sometimes they will use an ultrasound for greater accuracy and success but this is not always necessary.

Will it work straight away?

Once the anaesthetic is given, it can take up to 20 – 30 minutes to work.

What will it feel like?

Your arm will start to feel warm, heavy and numb.  You may have the sensation that your arm is in a different place to where it actually is (often the position that it was in when it was injected and before it goes numb).

Will I be awake?

Most patients stay awake for the whole procedure, which is one of the benefits of having a nerve block. The anaesthetist will discuss this with you beforehand. You may be offered sedation (a light sleep where you may be aware of what is going on around you) or a general anaesthetic (deep sleep with no awareness) as well.

Will I have to watch the surgery?

No. There will be members of the team who will be able to talk to you if you wish. You can bring along music to listen to or something to watch on your phone or on an iPad.  A screen will be used so that you cannot see the operation (unless you want to). 

Are there any advantages of having a Nerve block / regional anaesthetic?

Yes, there are:

  • You will have good pain relief after the operation and are less likely to need strong pain relief medication afterwards
  • With a block you can avoid the possible side effects of a general anaesthetic
    • General anaesthetics are extremely safe these days, but often people experience side effects such as sickness, sore throat and drowsiness afterwards. There can also be other less common potential (and rarely very serious) complications of having a general anaesthetic.
  • You are likely to be able to go home sooner after your operation than if you were given a general anaesthetic.

Do I have to have a nerve block?

No.  When you are seen before your surgery, your anaesthetist and surgeon will discuss the options with you.

Are there any complications and side effects of a nerve block?

There are some risks of having a nerve block, which are outlined below, as risks cannot be removed completely. However, anaesthetists and surgeons take a lot of care to reduce and avoid the risks. Your anaesthetist will be able to give you more information about any of these risks and the precautions taken to avoid them.

Risks associated with any nerve blocks

Local anaesthetics are generally very safe and serious problems are rare. You should not experience any significant side effects.

  • Common side effects of local anaesthetic injection include:
    • some discomfort when the injection is given
    • a tingling sensation as the medication wears off
    • possibly some minor bruising, bleeding or soreness where the injection was given
  • Some people experience temporary side effects from a local anaesthetic, such as:
  • dizziness
  • headaches
  • blurred vision
  • twitching muscles
  • continuing numbness, weakness or pins and needles

These problems will usually pass, but you should tell the healthcare professional in charge of your care if you experience any.

  • Blood vessels can be injured during the injection. The bleeding usually resolves with simple compression.
  • Nerve injury can occur during the injection but this is very uncommon.
    • About 1 in 10 patients may notice a prolonged patch of numbness or tingling in their arm. These symptoms will resolve in 95% of these patients within four to six weeks, and in 99% within a year.
    • Permanent nerve injury can happen in between 1 in 2,000 and 1 in 5,000 injections.

 Both of these complications are reduced by using an ultrasound to see the nerve and where the needle is.

Serious complications

Fortunately, serious complications are very rare. However, like any drug people can be sensitive, or vary rarely have an allergic reaction, to local anaesthetics.

 If you have had problems before, please make sure you tell your anaesthetist and surgeon.

  • Very rarely, a patient can have serious complications of local anaesthetics called Local Anaesthetic Systemic toxicity (including seizures and a serious allergic reaction – anaphylaxis). The incidence of this when using the ultrasound was estimated to be around 8.7 per 10000.

Specific risks depending on the site of injection

  • Injection on the side of the neck – can cause a droopy eyelid, hoarse voice or slight difficulty in breathing. These usually resolve completely as the nerve block wears off over 24 – 48 hours.
  • Injection around the collar bone – a very small risk of damaging the covering of the lung (known as a pneumothorax – 1 in 1000 patients).

Your anaesthetist will be able to discuss about these in detail.

How will it feel after the operation?

During the time the nerve block is working you will not be able to feel your arm or hand.  You will also not be able to use your arm. You will be given a sling to support the arm.

You may experience pins and needles in the blocked arm or hand, particularly when the anaesthetic starts to wear off. 

Do I need to do anything after the operation?

You should start taking your pain relief medicines before the nerve block wears off.

When you start feeling pins and needles, we suggest that you take some pain relief medication as you will have been advised in the hospital.

You should be careful around anything hot or sharp, as your numb arm will not be able to feel this and you may get a burn or a cut (e.g. hot objects such as hot water bottles, radiators etc.).

DO NOT operate machinery while the arm is numb as there is a potential for injury.

What if I have a problem after the operation?

You will need to seek help from the emergency medical services if you notice unexplained breathlessness, or severe pain that is not controlled by your tablets.

If your arm is still numb by 48 – 72 hours after the operation you should contact your anaesthetist by calling the anaesthetic department at Castle Hill Hospital (01482) 624096

If you have any questions or concerns before or after the operation regarding the nerve block, you can contact the Anaesthetic department at Castle Hill Hospital (01482) 624096. We will do our best to meet your needs.

Further Information

Please ask staff as many questions as necessary prior to the operation as many of the answers will be individual to you.

The Royal College of Anaesthetists website has lots of information for patients and carers. This publication includes text taken from Royal College of Anaesthetists (RCoA) leaflets ‘Nerve Blocks for Surgery on the Shoulder, arm and Hand 2015’ and ‘Nerve damage associated with peripheral nerve block 2017’.

Further information is available from the Royal College of Anaesthetists, and other websites:

www.rcoa.ac.uk/document-store/nerve-blocks-surgery-the-shoulder-arm-or-hand

www.rcoa.ac.uk/document -store/nerve- damage –associated- peripheral -nerve -block www.rcoa.ac.uk/patientinfo/risks/risk-leaflets,

www.rcoa.ac.uk/patientinfo/leaflets-video-resources

www.nhs.uk/conditions/local-anaesthesia/

References

Barrington.MJ Kluger.R. Ultrasound guidance reduces the risk of local anaesthetic systemic toxicity following peripheral nerve blockade. Reg Anaesth Pain Med2013; 38: 289–97

Nerve blocks for surgery on the shoulder arm or hand Information for patients and families. Royal College of anaesthetists

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

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