If you are scheduled to undergo shoulder or elbow surgery, one of the things we recommend is to find out as much as you can about the procedure you’re having so you feel well-informed, which can help to alleviate anxiety and avoid stress.
You may be wondering what type of anaesthetic you will be given for your particular condition. Here is a simple guide to the different types of anaesthetic and which is likely to be recommended when you go for surgery. Your surgeon and anaesthetist will always take your personal preferences into account so it is advisable to discuss any concerns you may have.
What does anaesthesia do?
The aim is to keep you comfortable during surgery, either by maintaining an unconscious state where you don’t experience any pain or by keeping you numb to any pain while you are awake. Your anaesthetist will aim to provide the right type and amount of anaesthetic to treat any pain, minimise side-effects and help you to recover from surgery.
What are the different types of anaesthetic?
Anaesthesia stops you from feeling pain. There are different types of anaesthetic, depending on the type of surgery you are having:
- Local anaesthetic – This involves injecting anaesthetic to a very localised part of your body. You will remain awake and conscious but you won’t feel any pain in the anaesthetised area. This very useful for smaller procedures such as carpal tunnel release or removal of skin lumps like a lipoma. It is also combined with a general anaesthetic for many elbow procedures such as tennis/golfer’s elbow release or ulnar nerve decompression.
- Regional anaesthetic (also called a nerve block) – This involves an injection around the nerve or nerves that supply feeling to the area of intended surgery. Because of the way that nerves flow from the spinal cord, the site of injection is always closer to the cord than the operation site (e.g. the neck for shoulder surgery or the shoulder for elbow surgery). It can numb a large area and give excellent pain relief for up to 36 hours after surgery.
- The disadvantage is that the injection is harder to do, often more uncomfortable to receive, involves an extremely small risk of nerve and blood vessel injury, and many patients experience ‘rebound’ discomfort after it wears off.
- To minimise this risk the injection is usually performed whilst you are awake so that you can inform the anaesthetist if you experience any abnormal tingling in your arm. A nerve stimulator and/or ultrasound is used to guide the needle as accurately as possible.
- In some circumstances regional anaesthesia is all that is needed and you can remain awake during the surgery. However, most often a supplementary light general anaesthetic is recommended, especially for shoulder surgery.
- There are often passing trends for ‘awake’ shoulder surgery without general anaesthetic. Although it is an attractive concept, all discomfort during the procedure is not reliably removed and patients often end up being heavily sedated, negating the benefits.
- Most surgeons report that the procedure is also compromised because the anaesthetist has no control over your blood pressure if it rises because of the discomfort.
- General anaesthetic – This is administered via a drip line injection and then you will be given gases during the operation to keep you asleep. A breathing tube is passed into your windpipe to keep it open and allow ventilation of your lungs. With this type of anaesthetic you will asleep throughout the procedure and unable to feel pain. During the operation, the anaesthetist may also give you pain medicine into your vein so you will have less pain when you wake up. Because excess painkillers and gases can make some people feel nauseous and drowsy on waking, many anaesthetists prefer to use a nerve block instead of painkillers, and a special technique called Total Intravenous Anaesthesia (TIVA) instead of gases.
What type of anaesthetic will I have?
Before your surgery you will be visited by the anaesthetist who will discuss the best type of anaesthetic for you. The best anaesthetic facilitates comfortable surgery, quick recovery and long-lasting pain relief. This will depend on a range of factors, including the procedure you are having, your general state of health and your preferences. Not all types of anaesthesia are suitable for everyone.
For example, people with severe lung or heart disease may not be able to safely have general anaesthetic and, similarly, people who are very needle phobic may not be suitable for some nerve blocks which should be done awake.
Commonly, we use a nerve block plus general anaesthetic for shoulder surgery. Suitable procedures include keyhole surgeries such as labral repairs, rotator cuff repairs, capsular release and acromioclavicular joint excision, as well as shoulder joint replacement surgery. An injection around the neck called an interscalene block is most commonly used. However, we also offer a ‘shoulder block’ which is an injection around more specific shoulder nerves and into the area of surgery itself. This is safely done when you are asleep and avoids the worry about an injection in the neck. It also reduces the chance of rebound pain the next day and means that the rest of the arm is not numb. The drawback is that slightly higher doses of painkiller are needed on the day of surgery.
Orthopaedic Consultant & Surgeon | London
Thames Shoulder & Elbow are able to provide advice and support to anyone experiencing symptoms affecting the upper limbs (shoulder, upper arm, elbow, forearm and wrist). We can also offer consultations either online or face-to-face.
Telephone: 020 376 15987