Hand surgery is usually performed as a day procedure under nerve block. The advantages of this are:
Safety: If you have many medical problems, or have side effects from general anaesthesia, having a block may be safer for you.
Better pain control: you will need less pain medicine.
Surgeon preference: for certain procedures, your surgeon may want you awake to perform certain tasks when testing repaired upper limb structures (tendons, nerves).
Less side effects: you will have less chance of being itchy, nauseous, sleepy or having trouble going to the bathroom.
You will go home sooner.
This is performed under light sedation in the anaesthetic bay immediately prior to your surgery. I use an ultrasound machine to locate the nerves in your upper arm that supply your hand and gently inject local anaesthetic around these nerves.
After 5-10 minutes, your forearm and hand will be weak and numb, and you will be transferred into the operating theatre for your surgery.
We always test the block prior to commencing surgery to ensure your comfort and safety. If discomfort is felt, a 2nd injection may be given to supplement the initial nerve block.
On completion of your surgery, your arm will be in a sling to provide protection while you have no feeling. Your nerve block will generally last 8-24 hours. I will provide an instruction sheet with a tailored plan on how to manage your pain when the nerve block wears off.
Please see the patient information section on Peripheral nerve blocks for further information.
Being ‘awake’ during surgery
A common misconception regarding nerve blocks is that you have to be awake during surgery.This is not a good reason to refuse to have a nerve block. In addition to your block, I can provide you with sedation, which renders you sleepy and unaware of their surroundings during the surgery.
For hand surgery, you will be lying flat with a sterile drape covering the arm being operated on.
I will be with you throughout your surgery to address any concerns you may have.
Post-operative pain relief
Prior to your surgery, please ensure you have ample supply of paracetamol and ibuprofen. Used together, these are very effective in managing pain and inflammation associated with hand surgery.
I will request you to take these regularly for at least 3 days after your procedure.
Paracetamol is taken 4 times per day (approximately every 6 hours)
Ibuprofen or Diclofenac is taken 3 times per day (approximately every 8 hours). I may sometimes request you not to take this if you have certain medical conditions.
I may provide a prescription for a stronger pain killer, in case this is required in addition to the paracetamol and your anti-inflammatory.