Anaesthetics for hand surgery

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 One of the most common questions asked is “what type of anaesthetic will I be having?”
 
There are 3 main options.

1. Local anaesthetic and sedation
   • the anaesthetist inserts a cannula in the opposite hand
     • used for IV antibiotics and light sedatives/ pain medication
   • Local Anaesthetic is infiltrated around the operative site
     • this is well tolerated due to the sedation
     • the surgical team then prepares and sterilises the operative field
     • only the operative site is anaesthetised so you will still feel some “poking and prodding”
     • if there is any discomfort or pain you are able to let the anaesthetist/ surgical team know
   • ideal for small or relatively quick procedures
   • safest anaesthetic for the elderly and medically frail
   • allows a very quick recovery (from the anaesthetic) and minimal if any “hangover” effects from the drugs given
   • has the advantage that the surgical team can ask you to move to check the surgical result eg. “make a fist” or “bend your finger”
   • trigger finger and carpal tunnel releases and are routinely performed with this method and it can be used for many other procedures

 

1. Regional block (and sedation)
   • the anaesthetist inserts a cannula in the opposite hand
     • Used for IV antibiotics and sedatives/ pain medication
   • the anaesthetist uses ultrasound to carefully inject local anaesthetic around the main nerves to the arm
     • The injection can be in the shoulder region, axilla or proximal forearm depending on anaesthetist preference and what is required for the operation
     • there is no feeling or movement in the hand or arm
   • this is an excellent form of anaesthesia for hand surgery
     • safe and effective
     • avoids the risks and side effects of a general anaesthetic
     • provides post operative pain relief until the block wears off

 

1. General anaesthetic (GA)
   • the anaesthetist inserts a cannula in the opposite hand
     • used for IV antibiotics and sedatives/ pain medication
   • in children, anaesthetic gas may be given through a mask before inserting the cannula (gas induction)
   • the GA is supplemented with local anaesthetic infiltration (or regional block) for post operative pain relief
   • this is the most common type of anaesthetic and the standard for children
   • more drugs are used so there is a higher rate of side effects including
     • nausea and vomiting
     • increase in post operative fatigue or “hangover” effect

 
 
 
 
For all anaesthetics, you will be advised regarding a “nil by mouth” period.  This must be observed to decrease the risk of serious airway complications (eg. vomiting and aspiration of stomach contents).

• No food for 6 hours
  • Clear fluids only (water or apple juice) can be consumed until 2 hours prior to the expected procedure time
• usual medication or pain relief should still be taken with a sip of water

 
Nb. Coffee, milk, soft drinks and orange juice are NOT considered clear fluids
 
Please note, the above information is a general guide only.  It does not provide details or information on the specific risks of anaesthetics.   Further information will be provided by your anaesthetist on the day of surgery.
 
 
 

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