Wide awake Surgery
This is a safe and commonly used type of anaesthesia in hand surgery whereby thanks to the use of local anaesthetic (LA) you can remain awake for your operation. Many hand operations are performed this way avoiding the need for a general anaesthetic as well as enjoying a faster recovery. There are basically 2 forms of ‘wide awake’ surgery – local anaesthetic (LA) infiltration and regional anaesthesia.
Local Anaesthetic infiltration
This is the same as the type of anaesthetic experienced at the dentists’. Local anaesthetic is injected at the site of surgery. This is typical for short surgical procedures such as carpal tunnel decompression and trigger release. You can still move your hand but you will not feel any pain. The LA will last for about 2-4 hours after injection. You will start to feel the effects wearing off later and as this happens do not forget to take take paracetamol or ibuprofen pre-emptively.
No starvation is required with local anaesthetic.
Regional Anaesthesia (‘Block’)
Regional anaesthetic is commonly referred to as a ‘block’ and is administered by the anaesthetist. This is when the anaesthetist injects LA into the armpit or around the collarbone to numb the whole arm. This is useful for longer procedures. It is an excellent option for those wanting to avoid general anaesthesia and much of hand / wrist surgery is now performed under regional due to it’s high safety and recovery profile.
Risks – The risk of damaging a nerve whilst administering regional anaesthesia is very low (1 in 24,000 to 1 in 54,000) and generally the risks around blocks are much lower than the risks of GA in certain patient groups. Patients with significant co-morbidities will be advised by their anaesthetists to have a regional instead of general anaesthetic as this will be safer for them.
If the block fails to take effect then sedation or general anaesthetic can be provided by the anaesthetist. This is unusual.
The block usually lasts several hours (12-24 hours) and during this time the arm has no spatial sense and the fingers can be temporarily paralysed. It is therefore important that someone can accompany you home at discharge.
Starvation beforehand, as with a GA , is required – 6 hours for food and 1 hour for clear water.
You can discuss the type of anaesthetic with your surgeon, at the pre-assessment clinic or with the anaesthetist on the day.
