Wrist surgery tmorrow. What's with the nerve block?
 

I'm having the plate and pins put in to fix a broken radius. 2 times now, I've been called by the nurses to go over procedures and each time they made a point to tell me about the avail nerve block which would be used in addition to the general. It smells to me that it must be controversial. Supposedly lowers the amount of narcotic needed in the gen, allowing you to wake sooner and with less nausea.

Anyone know anything about this before I talk to the docs tomorrow? Surgery at 1. thks

i think that any time a needle is inserted in or around a nerve that there is some risk. i do ABG's and there is some risk with that in cutting the nerve in the vicinity of the wrist.

its voluntary is why. they dont have to do it. they must ask your permission basically. it will be worth it though as it deadens everything and you will have zero pain for 24 hours..

The surgery will be done under general anesthesia (you're asleep). They're offering you either an axillary/interscalene/supraclavicular block in addition to the general anesthesia. Correct?

I think it's a good idea. Before the surgery, the anesthesiologist finds the appropriate nerves in the underarm/collar bone/neck base and injects them with local anesthetic. It'll deaden the pain post-operatively for many many hours (how long depends on what they use, but typically it'll last for 8+ hours post-op). This is something fairly routine, depending on the skill of the anesthesiologists.

Risks are fairly low. It's quite unlikely that they'll harm the nerve or hit an artery. Realistically the worst case scenario is that the block doesn't work as anticipated, and you will have gone through a slightly uncomfortable procedure without anything (good) to show for it.

If I was going to go through with an ORIF of a distal radius and someone offered this to me, I'd probably go for it.

You are concerned, so just talk to the anesthesiologist about it. Be blunt, ask specific questions. It will allay any concerns you have.

I think you should have no concerns tho.

One of my biking partners is an anesthesiologist. He and I were discussing the use of small ultrasound machines to help with the placement. The risk is much less these days, and it was pretty low when I had my knee surgery.

Blocks for shoulder surgery are very helpful with post op pain. Moving out to the elbow and wrist the benefit is a bit less because the pain is less. If less pain seems real attractive, then go for it. A great block placed enough ahead of time to see how well it sets up will let you skip the general and you can get by with sedation.

The best block for this surgery would be axillary, supraclavicular or infraclavicular brachial plexus blocks - preferably with ultrasound guidance and in the hands of someone who does a few a month. Interscalene blocks are very common because shoulder surgery is common and patients benefit a lot from them.

Other helpful blocks with minimal downside are femoral nerve blocks for total knees and ACL reconstructions as well as sciatic block for Tibia work - especially amputations. But let's not go there!

Enjoy the meds!

BTW - Stop eating NOW but drink all you want up till bedtime. Your stomach will be well rinsed and you will be tanked up for your IV.

They offered a nerve block when they put my thumb back together. I declined, it just didn't seem that worthwhile. Besides the stupid doses of meds they gave me afterwards were more than enough.
'Inject demorol' "How's that feel?"
"Still feels like someone took a dremel to my hand"
'Inject Toridol' "How's that feel?"
"Still hurts"
'Inject morphine' "How's that feel?"
"MMMFMFMMMMFFFFFFFFGGGGGG"

Usually demerol does the trick. Anesthesiologists around here use a lot more fentanyl than morphine.

I do practically everything with IV sedation and an ankle block, twilight sleep situation, no tube down the windpipe. When you are doing a block like that, you are aspirating prior injecting so you don't push it into a vessel. This of course would get the anesthesiologist all excited if you do it with Marcaine, which is rather cardiotoxic, as I understand it. They used to do what is called a Bier block, where they put a tourniquet on there and shoot a bunch of local anesthetic in your vein, generally lidocaine. If you do the nerve block, they can keep you lighter on the general anesthetic, this is better.

"If you have a choice between a general anesthetic and something else, you want something else." My mother, who practiced as an anesthesiologist for about 40 years, has always told me that.

Good luck with your surgery, don't forget to skip breakfast.

My dad had one for his shoulder... I will warn you to be good and doped up when that puppy wears off... He most certainly was not....

Nerve Block........
 

I just had shoulder surgery a week ago for a massive rotator cuff tear (courtesy of 20 yrs of martial arts!). The surgeon used a nerve block to help reduce the post surgical pain. From my experience, I would say to go for the nerve block. While my shoulder pain has been manageable, I would not have wanted to have to deal with any more! Good luck with your surgery.

thanks guys, truly appreciate it. I'll let you know what the A says. j

Late to contribute here but the posts offer good advice and experiences. The big ticket risks are nerve damage and intravascular injection of large doses of local anesthetic. Nerve damage may be temporary or permanent, annoying or debilitating or somewhere in the middle of those. Intravascular injections of local anesthetic will, in large enough dose, cause seizures and/or cardiac arrhythmia and/or cardiac arrest that may not respond to resuscitation. Ultrasound visualization of block placement is big advantage for everyone.

Having done a fair number of them, I'd take the block and ask that it be placed with ultrasound guidance.

Hope it went well!!

You want the nerve block. You just don't know it yet...

I had one when they put 8 bolts in my knee. You want this.
Gary

Had nerve block (underarm) when they fixed my hand after I was hit by a car on my bicycle.

Works great.

Arm numb for the rest of the day. No pain for at least 12 hours, then not much.

The downside is that say, your nose itches and the reflex is to scratch it with that hand, you can break your nose. You can move your arm but have no fine control. Your arm is basically a numb club.

Nurse said they have several broken noses each year. I only hit the side of my head.

I'd do it again.

I went through this over the winter. Broke both bones in my forearm near my wrist. The radius broke in half, with the bone jammed inward toward the wrist and ulna. The ulna was not broken completely in half, but a large chunk was broken off on the little finger side.

Same deal- ORIF to fix the radius. It took a plate and 9 screws.

In my case, a nerve block was not discussed prior to surgery. However, I came out of general anesthesia more quickly than they expected. I was in a lot of pain, so they gave me the nerve block. It took away all the pain while it lasted, but was a strange experience. It was as though my arm wasn't mine. Completely numb and paralyzed. If I recall correctly, it was like this for several hours. The sensation came back slowly over a few more hours.

As a suggestion, maybe you could ask them not to give you a nerve block as a matter of course, but to keep the option available in case you need it? In my case I definitely did. I hope your pain level is not too bad.

Good luck with your surgery and your recovery.

Good information-

I going to be having 2 surgeries at 1 time in the near future, 1st one to remove the plate and screws from my Right distal radius, shorten the ulna with a plate and screws.
2nd for a Left shoulder problem.
Both courtesy of machines with handlebars.
My friends say I'm not allowed to ride anything with handlebars.

Thanks,
Dave