Nerve blocks for shoulder or arm surgery are intended for patients undergoing shoulder surgery under general anesthesia, in combination with a brachial plexus block, to relieve pain after the procedure.
Brachial Plexus Block
The brachial plexus is a network of nerves located between the neck and armpit that controls movement and sensation throughout the entire arm, from the shoulder to the fingertips.
Nerves from the Neck to the Arm
An injection of local anesthetic in the neck, near the clavicle or in the armpit blocks these nerves: the arm becomes numb, heavy and immobile. The patient does not feel pain, although they may still feel movement or pressure when the arm is moved.
During general anesthesia, a lower dose of anesthetic is therefore sufficient, allowing the patient to wake up more quickly from anesthesia after the procedure and experience less pain. The block provides pain relief for up to 24 hours; in some areas, sensation may remain reduced for up to 48 hours. Not all anesthesiologists perform this procedure, as it is a specialist technique.
Benefits of the Block
The procedure relieves pain after surgery, reduces the need for strong painkillers, allows a lower dose of anesthetic to be used during general anesthesia, and contributes to faster recovery and earlier discharge from hospital.
How Is It Performed?
The patient receives the injection in a room near the operating theatre, with a sedative if necessary. The skin is first numbed with a local anesthetic. The anesthesiologist then locates the nerves using an ultrasound device and, in some cases, also with a small device that causes a slight twitch of the arm.
The arm initially feels warm and tingly, then gradually becomes heavy and numb. The effect develops within 20–40 minutes. The patient is taken to the operating theatre once the anesthesiologist has confirmed that the block is effective. If the block is not completely effective, additional anesthetic or other pain medication is administered.
After the Procedure and at Home
While the block is active, the arm is very heavy and should be supported with a sling. As the effect of the block wears off, tingling in the fingers is normal.
Numbness can last for up to 48 hours. During this period, the patient should be careful around sources of heat (cooktops, radiators), as reduced sensation may result in burns without the patient realizing it. It is also advisable to avoid operating machinery and household appliances.
Risks
Serious complications are rare. An injection in the neck may temporarily cause a hoarse voice, drooping eyelid or visual changes, which resolve as the effect of the block wears off.
The risk of pneumothorax, or partial collapse of the lung, which can be treated with drainage if necessary, is less than 1 in 1,000 cases when the injection is administered in the area of the clavicle.
Accidental puncture of a blood vessel at the injection site is relatively common (1 in 100 cases), but can be managed by applying pressure.
Nerve injury occurs in approximately 1 in 700 to 1 in 5,000 blocks. Mild, temporary tingling or numbness of the arm, which occurs in approximately 1 in 10 patients, resolves within six weeks in 95% of patients and within one year in 99% of patients.
The risk of stroke or another serious complication is very low.
If you experience unexplained shortness of breath or severe pain that cannot be controlled with painkillers, contact emergency medical services immediately.