There are several options for anesthesia for patients undergoing hand
surgery. These would include local anesthesia, general anesthesia, and
regional anesthesia. The type of anesthesia used depends on the nature
and duration of the surgery, patient’s health and any medical
conditions, and preferences of the patient, surgeon, and
“Local anesthesia” typically means anesthesia for a small
area, and may include injecting numbing medicine in the finger, or just
at the site of surgery, such as for a trigger finger or removing a small
lump. Sedative medications may be given to you, usually through an
intravenous line (IV), to help you relax during your surgery, too.
General anesthesia is when you are put to sleep for your surgery.
Newer medications and techniques make side effects such as nausea,
dizziness, and drowsiness less likely, though they can still
What is Regional Anesthesia?
Regional anesthesia puts part of your body to sleep by injecting
numbing medicine through a needle along the path of nerves. This may be
around the collarbone, under the arm, or through an intravenous (IV)
line in your arm. There are several different types of regional
Axillary Block: The numbing medicine is injected
under the armpit (the axilla) to numb the brachial plexus, the network
of nerves below the neck and collarbone that ultimately branch out into
the nerves that supply the arm, forearm, and hand. This generally
provides good anesthesia for hand, wrist, forearm, and elbow
Interscalene Block: The numbing medicine is injected
towards the brachial plexus between the scalene muscles, which are at
the base of the neck above the collarbone (clavicle). This type of
regional anesthesia provides good anesthesia for hand, wrist, forearm,
and often shoulder surgery.
Infraclavicular Block: The numbing medication is
injected towards the brachial plexus below the collarbone (clavicle).
This generally provides good anesthesia for hand, wrist, forearm, and
Bier Block: The numbing medicine is injected through
an IV line in the arm being operated on, with a tourniquet around the
upper part of your arm to hold the medicine in the arm, preventing it
from leaking out to the rest of your body. This type of block is useful
for short procedures such as carpal tunnel surgery.
Wrist Block: The numbing medicine is injected near
the nerves at the wrist (median, ulnar) to numb the hand and
Some of the proven advantages of choosing regional anesthesia as part
of your anesthetic include better postoperative pain relief, less
narcotic use (drugs related to morphine such as Fentanyl and Vicodin),
faster recovery, less nausea, and, for some surgeries, less blood loss
and less risk of blood clots.
The injection of numbing medicine with a needle can be slightly
uncomfortable or painful, but you will have IV medication to help you
relax and feel comfortable during block placement. Often times a small
amount of local anesthetic is injected around the site where the block
needle is placed. The anesthesiologist may use a stimulating needle to
precisely locate the nerve. This causes the arm or hand muscles to
twitch and move, which is not painful, although it can feel strange.
Placing the block usually takes around 5 to 15 minutes and numbness
comes on over 10 or 20 minutes. The numbing medications used in regional
anesthesia can provide from 1 to 24 hours of pain relief, depending on
the specific medication used. The muscles controlled by the nerves that
are blocked may also be weak until the block wears off. You will be
given back-up pain medicine by mouth or by IV, in addition to the
numbing medicine in the block.
Having surgery under regional anesthesia means that the part of your
body that will be operated upon will be numb during the surgery. Some
patients prefer to be awake during surgery. Others prefer to be asleep.
During your surgery you can be as awake or as asleep as you and the
surgical team (surgeon and anesthesiologist) decide. Sometimes general
anesthesia is recommended as well as the regional block. Your
anesthesiologist will discuss this with you before the surgery. You will
not be able to see the surgery itself because a large sterile drape is
placed between you and the surgeon. This isCAto protect the
“sterile field, the important area of your surgery, from any
As with any anesthetic, there are risks associated with the benefits
of regional anesthesia. These include incomplete pain relief, soreness
or bruising at the needle site, or tingling that lasts for several days.
Serious complications can occur but these are very rare: significant
bleeding, infection, or nerve injury.
No, you can decline regional anesthesia. Anesthesiologists offer this
option because it has advantages for your comfort and recovery.
Occasionally there are medical reasons for strongly advising you to
choose regional anesthesia, which has fewer side effects on major
organs. Patients with significant heart or lung disease, for example,
who need surgery, may be advised to have regional anesthesia. Your
anesthesiologist will discuss this with you.
© 2006 American Society for Surgery of the Hand