Surgery on Upper Body
When you have surgery, you need to have an anesthetic. For surgery on
the hand, arm, or shoulder, there are several different kinds of
anesthetic we can use. This pamphlet was written to help you decide
which type you prefer. There may also be special concerns that apply to
you. When you talk to the anesthetist, he or she will discuss the
choices in more detail. Together, you can decide which one is best for
you.
Local Anesthesia
A local anesthetic means injecting freezing medicine around the site of surgery. This is very useful for small areas such as a finger or small patch of skin. It is often used for procedures outside the operating room, like your doctor's office. It sometimes does not work well if the surgery involves a large area.
Local anesthesia has several advantages. Compared to regional anesthesia, less area is frozen, so it feels more natural. Compared to general anesthesia, patients tend to feel less drowsy and less nauseated after the surgery. The local anesthetic can keep the area frozen for several hours. This helps with pain control after surgery.
With local anesthesia, you have the choice of being awake or sleepy. The anesthetist can use medication to make you feel relaxed or sleepy if you like.
Local anesthetic is injected with a needle. The needle is very small, and not very uncomfortable. Sometimes, more than one injection is needed.
Sometimes the surgeon uses a tourniquet around the upper arm. This is a tight band used to control bleeding. At the end of the surgery, it is removed. Local anesthesia is usually not comfortable for long procedures that need a tourniquet
Regional Anesthesia
A regional anesthetic is a nerve block. It is similar to a local anesthetic, except that the anesthetic is not injected directly at the site of surgery. Instead, we freeze the nerves that go to the area with an injection higher up the arm. This can be done at the hand, wrist, elbow, armpit, or neck. That way, we can freeze a much larger area with fewer injections.
There are several advantages to regional anesthesia. If the area to be frozen is large, fewer injections are needed than with local anesthesia. There are less drowsiness and nausea than with a general anesthetic. You can be awake or sleepy, just like with a local anesthetic.
Regional anesthesia is similar to local anesthesia. A small needle is used to inject the freezing. This is mildly uncomfortable. Compared to a local anesthetic, more of the arm gets frozen. This is important if a tourniquet is used. Until the freezing wears off, you have no pain. You also can't use your arm while it is numb. We can use short- or long-lasting freezing. The long-lasting type lasts up to 24 hours.
With either regional or local anesthesia, it is possible that the freezing will not work well. The freezing is tested before starting the surgery. If it is not working well, we either fix it, or give you a general anesthetic.
General Anesthesia
Most people think of a general anesthetic as going to sleep. A general anesthetic is different from natural sleep. If someone cut you while you were asleep at night you would wake up! A general anesthetic makes you more deeply unconscious, so you don't feel anything.
First, we give you oxygen to breathe from a rubber mask. While you breathe the oxygen, we give you some medication in the intravenous that makes you fall asleep. After you are asleep, we keep you asleep with a combination of gas and intravenous medication.
The main advantage of general anesthesia is that all the medications go into the intravenous tubing. There is no need for more needles. This is very important to some people, and not to others. The disadvantages are that you stay drowsy longer, are more likely to have nausea or vomiting, and are more likely to need painkillers afterward. Sometimes, we need to put a breathing tube into your windpipe after you are asleep. This may cause a sore throat that can last a few days.
Risks of Anesthetics
The risk with any type of anesthetic in healthy people is very low. The chance of dying from an anesthetic is less than one in 50,000 . All anesthetics have a chance of serious complications. Breathing problems are the most common serious problem. Nerve injuries are a rare but sometimes serious complication. With regional anesthesia, the risk of nerve injury is very low, but not exactly known. The risk of nerve injury with general anesthesia is about one in three thousand patients. The result of a nerve injury can be losing feeling or strength in some area. Most injuries go away in a few weeks. Very rarely, they can be permanent. Because serious problems are so rare, the difference between anesthetics is seen more in the minor problems.
The needle poke and being unable to use your arm for a while would be minor problems with local or regional anesthesia.
Minor problems with general anesthetics include nausea, drowsiness, sore throat, and more need for painkillers.
This pamphlet does not cover all the details about the different anesthetics, but explains the important aspects. You will have a chance to discuss any questions with your anesthetist before the surgery. We hope to make your surgical experience comfortable, and wish you a speedy recovery.
Local Anesthesia
A local anesthetic means injecting freezing medicine around the site of surgery. This is very useful for small areas such as a finger or small patch of skin. It is often used for procedures outside the operating room, like your doctor's office. It sometimes does not work well if the surgery involves a large area.
Local anesthesia has several advantages. Compared to regional anesthesia, less area is frozen, so it feels more natural. Compared to general anesthesia, patients tend to feel less drowsy and less nauseated after the surgery. The local anesthetic can keep the area frozen for several hours. This helps with pain control after surgery.
With local anesthesia, you have the choice of being awake or sleepy. The anesthetist can use medication to make you feel relaxed or sleepy if you like.
Local anesthetic is injected with a needle. The needle is very small, and not very uncomfortable. Sometimes, more than one injection is needed.
Sometimes the surgeon uses a tourniquet around the upper arm. This is a tight band used to control bleeding. At the end of the surgery, it is removed. Local anesthesia is usually not comfortable for long procedures that need a tourniquet
Regional Anesthesia
A regional anesthetic is a nerve block. It is similar to a local anesthetic, except that the anesthetic is not injected directly at the site of surgery. Instead, we freeze the nerves that go to the area with an injection higher up the arm. This can be done at the hand, wrist, elbow, armpit, or neck. That way, we can freeze a much larger area with fewer injections.
There are several advantages to regional anesthesia. If the area to be frozen is large, fewer injections are needed than with local anesthesia. There are less drowsiness and nausea than with a general anesthetic. You can be awake or sleepy, just like with a local anesthetic.
Regional anesthesia is similar to local anesthesia. A small needle is used to inject the freezing. This is mildly uncomfortable. Compared to a local anesthetic, more of the arm gets frozen. This is important if a tourniquet is used. Until the freezing wears off, you have no pain. You also can't use your arm while it is numb. We can use short- or long-lasting freezing. The long-lasting type lasts up to 24 hours.
With either regional or local anesthesia, it is possible that the freezing will not work well. The freezing is tested before starting the surgery. If it is not working well, we either fix it, or give you a general anesthetic.
General Anesthesia
Most people think of a general anesthetic as going to sleep. A general anesthetic is different from natural sleep. If someone cut you while you were asleep at night you would wake up! A general anesthetic makes you more deeply unconscious, so you don't feel anything.
First, we give you oxygen to breathe from a rubber mask. While you breathe the oxygen, we give you some medication in the intravenous that makes you fall asleep. After you are asleep, we keep you asleep with a combination of gas and intravenous medication.
The main advantage of general anesthesia is that all the medications go into the intravenous tubing. There is no need for more needles. This is very important to some people, and not to others. The disadvantages are that you stay drowsy longer, are more likely to have nausea or vomiting, and are more likely to need painkillers afterward. Sometimes, we need to put a breathing tube into your windpipe after you are asleep. This may cause a sore throat that can last a few days.
Risks of Anesthetics
The risk with any type of anesthetic in healthy people is very low. The chance of dying from an anesthetic is less than one in 50,000 . All anesthetics have a chance of serious complications. Breathing problems are the most common serious problem. Nerve injuries are a rare but sometimes serious complication. With regional anesthesia, the risk of nerve injury is very low, but not exactly known. The risk of nerve injury with general anesthesia is about one in three thousand patients. The result of a nerve injury can be losing feeling or strength in some area. Most injuries go away in a few weeks. Very rarely, they can be permanent. Because serious problems are so rare, the difference between anesthetics is seen more in the minor problems.
The needle poke and being unable to use your arm for a while would be minor problems with local or regional anesthesia.
Minor problems with general anesthetics include nausea, drowsiness, sore throat, and more need for painkillers.
This pamphlet does not cover all the details about the different anesthetics, but explains the important aspects. You will have a chance to discuss any questions with your anesthetist before the surgery. We hope to make your surgical experience comfortable, and wish you a speedy recovery.