Local Anesthesia in Hand Surgery

Of all the types of anesthesia available for surgeons and patients, local anesthesia has the most advantages for the hand surgeon.

Local anesthesia involves numbing up an area of the hand or wrist before a procedure is performed. This can be used in the office or in the operating room.

I usually use a combination of quick-acting and long-acting local anesthetic medicine – lidocaine and bupivicaine (Marcaine).

Surgeries performed under local anesthetic

Many hand surgeries can be performed under local anesthetic. Here are some examples:

• carpal tunnel release
• trigger finger release
• DeQuervain’s tenosynovitis surgery
• fingertip surgery (fractures or amputation surgery)
• other hand fractures

Just because these surgeries can be performed doesn’t mean they should be performed under local anesthetic – that’s a decision you’ll have to make with your surgeon.

What can you expect in the operating room during a surgery performed under local anesthetic?

When only local anesthesia is used, you will be awake during the nerve block (giving the shot of anesthetic medicine and numbing up the area) and during the surgery. Sometimes taking a mild sedative pill the morning of surgery will help some of the anxiety associated with the shot and the surgery.

In surgery, you will hear everything going on inside the operating room. This may involve the sound of

• people talking
• drills and machinery
• the surgeon’s music

You won’t see the surgery – there will be a sterile drape between you and the surgeon working on your hand.

Making sure you’re numb

During the surgery, you will feel the pressure of the surgeon working on your hand, but will feel no sharp pain. I always test the surgical incision area with something pointy to see if you feel sharp sensation or just dull pressure on your skin.

After you’ve been numbed up, I’ll touch you with something pointy and say, “Does this feel sharp or dull?”.

If you still feel sharp pain, I’ll just add some more anesthetic – usually through the previously numbed-up skin and re-test you before starting the surgery.

Why numbing shots don’t work

The most common reason local anesthetic doesn’t work is because the surgeon didn’t allow enough time to let the medicine work. Often the nerve block will take five to ten minutes to work completely.

Very rarely a patient will be resistant to local anesthetic medicine. If you have trouble getting numb at the dentist’s office be sure to tell your surgeon before any type of local anesthetic procedure.

Advantages of local anesthetic

• no drowsiness from general anesthetic or intravenous sedation
• you don’t lose control
• the surgeon can ask you questions during the surgery
• depending on the specific situation, you may be able to drive yourself to and from surgery
• pain relief for hours after the surgery – may cut down on use of pain pills afterwards
• limited and rare side effects (reaction to the injected drug is rare)

Disadvantages of local anesthetic

• you hear everything that goes on in the operating room
• the pressure you may feel when the surgeon is working may be unnerving
• there is some brief pain during the numbing shot before surgery
• most big, complex surgeries are not possible under local anesthetic

Ask your surgeon if your surgery can be performed with local anesthetic!