Anaesthesia stops you feeling pain and other sensations. It can be given in various ways:
We generally use a general anesthetic with either a local anesthetic or an interscalene block to ensure the best post-operative pain relief is achieved and you can go home earlier.
Your anesthetist will see you before your shoulder surgery and discuss your anesthetic with you. Please indicate any preferences and concerns then. If you would like to meet your anesthetist before the day of your operation, please let your orthopaedic surgeon know so it can be arranged for you.
An Interscalene block (ISB) is a nerve block in the neck used to provide excellent pain relief for shoulder surgery carried out under general anesthesia. It numbs the main nerve bundles that affects the shoulder in the same way a dentist uses an injection to numb a tooth or part of your mouth.
The benefits of an interscalene nerve block (ISB) for shoulder surgery are:
The anesthetist, Dr van den Berg and you need to decide collectively whether you are suitable for an ISB. You may not be suitable for an ISB if:
You will usually already be under anesthetic before the ISB is done, although sometimes it is done whilst you are awake. If you have an ISB performed whilst you are awake, the anesthetist may give you some light sedation to help you to relax.
A special needle with a small electric pulse is used to locate the correct nerves. To judge the position of the injection, the anesthetist looks for muscle twitches in the arm. When the anesthetist is happy with the position of the needle, he or she injects some local anesthetic. The arm and shoulder soon become heavy and numb. The anesthetist will test the numbness of the arm before proceeding further.
As your orthopaedic surgeon, Dr van den Berg will discuss your surgery details and what you can expect after surgery with you before you are admitted.
The main nerve block technique used in shoulder surgery is a single injection that lasts 12-24 hours. After leaving the hospital, it is extremely important that you take regular pain killers at the prescribed times from the moment of discharge. This is to avoid unpleasant pain at the time when the nerve block begins to wear off (which can be in the middle of the night). Pain killers will be prescribed by Dr van den Berg in the form of regular paracetamol and ibuprofen, and codeine if required (if there is no reason why you cannot take these pain killers).
Your orthopaedic surgeon will advised that you carry the “numb“ arm in an arm sling until normal sensation and motor function return. You should receive instructions about how to look after the shoulder and arm - it should be protected from heat or pressure injury and extremes of movement. You should take care not be come in contact with extremely hot or cold items because you will not be able to protect yourself from injuries of extremes of temperature.
Most side effects are related to the local anesthetic spreading and numbing the nerves adjacent to the ones that supply the shoulder and arm. Any or all the following can occur, but all resolve spontaneously as the effects of the local anesthetic wear off:
These are the result of the needle being inserted either in the wrong direction or too far. They are both extremely rare and easily dealt with, with little no aftereffects.
Fortunately, the serious side effects and complications are uncommon and are lessened by placement of block with use of a nerve stimulator.