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Anesthetic methods for hand surgery
- Local infiltration anesthesia:
A specified amount of numbing agent is injected into the site to be operated upon.
Suitable for: e.g. wound treatment,
removal of small tumors, removal of foreign objects, scar correction.
Disadvantage: Exsanguination (ischemia) only possible
for a relatively short time period.
- Nerve blocks
- Nerve block using Oberst's method:
A local numbing agent is injected from the dorsal aspect at the base of the finger, creating a pain free area on the finger distal from the injection site.
Suitable for: e.g. smaller scale operations of the finger that occur distal to the site of exsanguination
Disadvantage: Patient experiences no pain and can not see the operation occurring through the curtain but does sense
that "someone is working on his hand".
- Blockade of the middle hand:
It is possible to inject a numbing agent on the extensor side of the hand on both sides of the middle hand bone. Due to the larger area, a larger amount of local anesthesia is needed.
Suitable for: e.g. smaller scale operations on the finger base joints, reposition (adjustment) after luxation (dislocation),
with the use of a long lasting numbing agent for pain management after operation of the fingers (pain free for 5-8 hours).
Disadvantage: as described for nerve blocks using Oberst's method above.
- Blockade of the median nerve in the wrist area:
A dose of local numbing agent is injected in to the distal anterior mid-side of the wrist under the forearm fascia.
Correct application results in a complete elimination of pain in the area of the hand and arm connected to the median nerve.
Suitable for: e.g. smaller scale operations that occur in parts of the hand and arm connected to the median nerve.
Disadvantage: The exsanguination is only tolerated by the patient for about 20-25 minutes before intense pain is
experienced in the area of the cuff on the upper arm.
- Blockade of the ulnar nerve in the wrist area:
A dose of local numbing agent is injected in to the distal anterior ulnar side of the wrist under the forearm fascia.
Correct application results in a complete elimination of pain in the area of the hand and arm connected to the ulnar nerve.
Suitable for: e.g. smaller scale operations that occur in parts of the hand and arm connected to the ulnar nerve.
Disadvantage: The exsanguination is only tolerated by the patient for about 20-25 minutes before intense pain is
experienced in the area of the cuff on the upper arm.
- Blockade of the ulnar nerve in the elbow area:
In the so-called ulnar groove of the elbow, an injection of a dose of numbing agent blocks the functioning of the ulnar nerve.
Due to the fact that the other methods are more reliable, this type of anesthesia is rarely used.
- Blockade of the median nerve in the elbow area:
An injection into the palmar side of the elbow of a dose of numbing agent blocks the functioning of the median nerve.
Due to the fact that the other methods are more reliable, this type of anesthesia is rarely used.
- Plexus blockade:
One of the most commonly used forms of anesthesia for hand surgery which allows for a pain free blood restriction
for up to two hours and allows for operating time of several hours.
Suitable for: all operations of the hand
Disadvantage: The patient experiences no pain but can sense that the hand is manipulated.
- Axillary plexus block:
Numbing of the brachial plexus in the arm pit.
- Supraclavicular:
Numbing of the brachial plexus under the collar bone.
- Interscalenus:
Numbing of the brachial plexus between the so-called scalenus muscles in the neck. This is used for operations of the shoulder area and the outside of the arm.
- Intravenous regional anesthesia:
After placing an exsanguination cuff on the upper arm, a local numbing agent is administered through a previously inserted I.V. (venous canula)
which passes first through the veins of the arm and then diffuses into the tissue which is then pain free after 10-15 minutes.
Suitable for: all small, relatively brief operations of the hand.
Disadvantage: The patient experiences no pain but can sense that the hand is manipulated. Once the blood is allowed to reenter the arm,
the patient is only pain free for a few more minutes.
- Intubation anesthesia (general anesthesia):
The surest and fastest method for eliminating pain as the patient sleeps and is unconscious of the operating procedures.
Suitable for: all involved hand surgeries that require extended time, when simultaneous bone transplants (e.g. from hip to hand or arm)
are undertaken, for nervous patients.
Disadvantage: General anesthesia is often associated with a higher risk. However, the experience of the last 8 years in our surgical clinic
(approximately 4000 surgeries per year) does not validate these concerns.
Important for all types of anesthesia is a good preliminary examination and preparation of the patient as well as the over-seeing of the operation
and anesthetic procedures by the appropriate physicians and personnel (Anesthesiologist, Anesthesia nurse).
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