Hand Surgery Anesthesia

Anesthesia is a way to control a patient’s comfort and awareness using medication during a surgery or procedure. The types of medications used for this purpose are called anesthetics. Anesthesia can help control breathing, blood pressure, memory, pain perception, and heart rate.

There are several types of anesthesia for patients undergoing hand surgery. These include:

  • General anesthesia
  • Local anesthesia
  • Monitored anesthesia care
  • Regional anesthesia

The type of anesthesia used for each hand surgery depends on several factors. The first is the surgery itself, including the type and length of the procedure. The patient’s health and other medical conditions are also considered. Finally, and most importantly, the preferences of the patient, surgeon, and anesthesiologist are taken into account. Together, the patient and the treatment team decide on a type of anesthesia.

General Anesthesia

With general anesthesia, medications are given that put the patient in a temporary state that is similar to being unconscious. They have no awareness and do not form memories during the surgery. The patient is put to sleep by the gas they are inhaling or the medications in their IV. With this type of anesthesia, the patient requires careful observation of their vital signs, airway, and breathing support from a ventilator. The anesthesiologist also has medications and treatments that can reverse the process and awaken the patient at the end of the surgery safely. This may be done for children, by patient preference, and for longer or emergent cases.

Local Anesthesia (WALANT – Wide Awake Local Anesthesia No Tourniquet)

This typically means anesthetics for a small body area and is very common in hand surgery. Numbing medicine is injected at the site of surgery. There are different types of local anesthetic medications that last for different amounts of time. Some may last for only one or two hours, and others may last for eight hours or more. When local anesthesia is used alone, the patient can be wide awake during the surgery. Sometimes, epinephrine may be mixed with the local anesthetic to temporarily constrict the blood vessels and limit excessive bleeding. This may temporarily make the skin look pale where the medication is injected. The patient can cooperate with instructions from the surgeon. Sometimes, the surgeon may ask the patient to move their hand or fingers to check movement after a trigger finger release or a tendon repair.

Monitored Anesthesia Care (Sedation)

This type of anesthesia helps the patient relax and experience less stress by receiving unique medications through an IV line. While on these medicines, patients often are not aware of the events around surgery and have no memory of the procedure, even though they may be awake (though most patients fall asleep). With this type of anesthesia, a breathing tube is not needed because the patient is able to breathe on their own, but oxygen is often supplied for support. This helps reduce the risk of having general anesthesia. This type of anesthesia is often given by the anesthesia team in combination with local anesthetics injected by the hand surgeon to numb the area.

Regional Anesthesia

With regional anesthesia, specific parts of the body are put to sleep by injecting numbing medicine through a needle or catheter placed along the path of the targeted nerves. This may be around the collarbone or neck, under the arm, at the wrist, in the palm, or around the finger. As with local anesthesia, relaxing medication may be given through an IV line, as well. Regional anesthesia uses numbing medications that can provide between one and 24 hours of pain relief. Many times, an ultrasound is used to visualize blood vessels, landmarks, and nerves, and to guide the numbing medicine or catheter placement. Other times, a nerve stimulator is used to help place the medication close to the nerves. This stimulator can cause the arm or hand muscles to twitch and move, which while not painful can feel strange. To limit pain during the injection of numbing medicine with a needle, IV medication may be given to help the patient relax and feel comfortable.

Some benefits of this type of anesthesia include longer numbness than local medications and less need for pain medicine during and after surgery. It has also been linked to faster recovery and less nausea. For some surgeries, regional anesthesia is linked to less blood loss and a lower risk of blood clots. It is however an additional procedure to the hand surgery and includes the additional risk of complications.

Will I Be Awake During Surgery?

Some patients prefer to be awake during surgery. Others prefer to be asleep or unaware. During your surgery, you can be awake or asleep, depending on which type of anesthesia you and the treatment team select. You will not be able to see the surgery itself because of the large sterile drape placed between you and the surgeon for your safety. This is to protect the “sterile field.” The “sterile field” is the important area of your surgery, kept clean and free from germs that can cause an infection.

What Are the Risks?

Some risks associated with regional or local anesthesia include pain, soreness, or bruising at the needle site. Sometimes, your pupil may change size, and muscles that move the diaphragm may get numbed and may temporarily require support. The regional anesthesia may not be effective for the intended area and require to be converted to general anesthesia, although this is not common. Serious complications can also occur. These include death, bleeding, infection, and limb or nerve injury, but these are very rare. Your surgeon and anesthesiologist will check to make sure you are comfortable before, during, and after the procedure. Do not hesitate to tell them your preferences or have questions about risk, benefits, and alternatives to each surgery and type of anesthesia for your hand surgery.

© 2022 American Society for Surgery of the Hand

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.

Figure 1
Diagram of the regional blocks used to numb the nerves in the arm with anesthesia.
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