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| Brachial Plexus Block |
Introduction
The surgeon or anaesthetist caring for you has suggested you have a regional block, which is a local anaesthetic for your shoulder and arm. We hope this gives you a clear picture of what it is all about. If you have any questions after reading this, or would like to talk it through with your anaesthetist, please do not hesitate to do so.
What is a regional block?
It is an injection of local anaesthetic, usually performed at the top part of your shoulder, the lower part of your neck, to cause temporary numbness of your shoulder and arm. This will help with pain relief during and after your shoulder operation.
Why do I need one?
The aim is to make the shoulder, and usually the whole arm, go numb, for a number of hours (about 18-24 hrs depending on the choice of local anaesthetic.)This will mean that you will need fewer painkillers immediately after the operation. Remember many of the painkillers have their own side-effects. In addition, if you require physiotherapy back on the ward, this can be done with minimal discomfort.
Can everyone have a “block”?
Very few people are unsuitable for a regional block. If you have a bleeding disorder, or you are taking medication to prevent blood clots then it is probably not advisable. Patients with severe respiratory disease may be unsuitable. If you have had previous or have existing nerve damage to your neck, arm or shoulder your anaesthetist will discuss this with you further, and advise you.
Will I have a General Anaesthetic as well?
Most patients will have a regional block and a GA. Occasionally patients may stay awake during the procedure if it is appropriate, and if they want to.
How do you do the block?
The injection for the block will be performed immediately before surgery. When you arrive in the anaesthetic room the anaesthetist will put a small needle in your other hand in order to give you any medicine you may need, and will connect some monitors to check your heart rate and blood pressure.
The side of your neck will be cleaned with a cleaning fluid, and a small injection will be put into your skin, causing a slight burning sensation. This is to numb the skin. Then the anaesthetist will insert another needle, a bit deeper than the first. A nerve stimulator is used to help locate the nerves. This small gadget will cause your muscles to twitch slightly, or you may feel pins-and-needles in your arm or shoulder. This only lasts for a moment. When the correct nerves have been located, the anaesthetist will inject some local anaesthetic around them. The anaesthetist may ask you if you feel tingling or a sharp pain anywhere in the arm while he/she is doing the block. You may feel a sensation of pressure in your neck.
Many anaesthetists will offer to sedate you in order to perform the block. This may make you feel more relaxed and slightly sleepy.
The local anaesthetic needs time to penetrate the nerves, so you may be moved into a waiting area for 30mins or so, where you can sleep, listen to music or talk to the nurses. You may be given a general anaesthetic straight away and taken into the operating theatre.
How does it work?
The local anaesthetic works by blocking messages passing up and down your arm. Your brain cannot tell your arm to move and your arm cannot tell your brain that it is sore.
What will it feel like?
Your shoulder and possibly whole arm will become heavy. You may feel pressure but you will not feel pain, and it will feel as if it doesn’t belong to you. You will not even know where it is unless you look at it!
When does it wear off?
The length of time your shoulder is numb will depend on the dose and choice of local anaesthetic your doctor has used, typically around 18 hours. You may be given some additional painkillers to help with the pain as the block wears off. It wears off gradually, and you will feel the sensation returning as tingling in the arm.
What are the benefits?
When your shoulder is completely numb you will have the benefit of excellent pain relief after surgery. This is important for during your operation too, as it will mean that your body will respond less to the surgery. There may be reduced bleeding and your blood pressure may be easier to control.
Are there any side effects of the block?
In addition to the numbness of your arm, you may also get numbness of your face or side of your neck. It is common to experience a hoarse voice, blurred vision, a droopy eyelid and congestion of your nose, all on the side of the block. These are all minor side-effects which disappear when the local anaesthetic has worn off.
Occasionally the block doesn’t work, and the anaesthetist will give you additional painkillers during the operation to make sure you are comfortable after surgery.
What are the risks?
Like all procedures there are risks, but if it is performed by a skilled anaesthetist the risks are very small. The most serious risk is nerve damage, which can occur 1 in 5000 patients receiving a block. Also you may get some bleeding and bruising at the site of the injection. Your anaesthetist will always take great care and use their skill and expertise when performing the block, to minimise any such risk.
What happens if I don’t want a block?
Your anaesthetist will visit you before your operation to discuss all aspects of your anaesthetic, including the possibility of a regional block. If you would prefer not to have a block or if you are not suitable, then there are very good alternatives. A combination of painkillers, including morphine, will be given to you when you are asleep under general anaesthetic.