Types of anesthesia
Local anesthesia: Many hand surgery procedures can be done under local anesthesia. This has many advantages: You can eat and drink normally on the day of surgery (so no need to skip the morning coffee), there's no post-anesthesia fog, and you can keep your street clothes on. If you want, you can even can pick the music in the operating room. You will still be lying down during the surgery, and so unfortunately or fortunately (depending on your perspective), you won't be able to see much of the procedure. Dr. Williams or a nurse will give you a shot of numbing medication before the surgery so that you don't feel any pain, although you may still feel tugging or pressure. There may be a tourniquet around your arm during the surgery that will feel like a tight blood pressure cuff. You will be completely awake throughout the procedure.
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General anesthesia: Some longer/more invasive procedures are performed with a general anesthetic. That means that you will be given medication to induce sleep for the duration of the surgery. In addition to this medication, you will typically receive a regional block. That means that the surgical site will numbed. This will keep you from feeling any pain during the procedure. It also allows the anesthesiologist to use less general anesthetic, so you will wake up more easily and with a lower chance of anesthesia side effects. We use these regional blocks most often:
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· Bier block: You will receive two IVs before surgery: one on the nonsurgical side, and one on the surgical side. In the operating room, a tourniquet will be placed on the surgical side around the forearm or upper arm. Once the tourniquet is inflated, numbing medication will be injected into a vein via the IV on the surgical side. The numbing medication then diffuses throughout the arm. The numbness wears off shortly after the tourniquet is taken down at the conclusion of the procedure.
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· Brachial plexus block: Before surgery, using ultrasound guidance, an anesthesiologist will use a needle to inject numbing medication around the large nerves in your neck/shoulder that travel down the arm. This puts these nerves to sleep temporarily. These blocks last longer than Bier blocks, sometimes even up to 24 hours, and so they provide more prolonged pain relief after surgery. After surgery, you will need to wear a sling until the block wears off, because your arm will be completely asleep.
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