About upper limb nerve block

  • Nerve block is a common anaesthesia technique used for arm and shoulder surgery. 
  • Nerve block involves injecting local anaesthetic around specific nerves. This numbs and blocks pain signals to your brain from a region of your body.
  • We can perform a nerve block while you are awake, or under sedation or asleep.  On the day of your surgery, your anaesthetist will decide and discuss this with you.
  • The nerve block is optional. If you choose not to have the nerve block, we will treat you with intravenous (via a vein) or oral (by mouth) painkillers instead. 

Benefits and risks of using the block

Benefits

  • The block gives better pain relief after surgery than oral painkillers alone.
  • Strong painkillers, whether oral or intravenous, can make you feel drowsy and sick.
  • If you have the block, you may need less painkiller in general.
  • The block may work so well that you can avoid having a general anaesthetic for your surgery.  (Under general anaesthetic, you are completely unconscious.) 
  • Using the block means you may be able to go home sooner, after your surgery.

Risks

Nerve blocks are safe and effective and your anaesthetist will take great care to minimise potential risks.  Potential risks are as follows.

Failure to prevent pain

  • The block may not work well and you may still feel some pain. 
  • If this happens, we may manage your pain by using another anaesthetic for your surgery, and additional painkillers after your operation.

Numbness, tingling and weakness

  • Fewer than 1 in 10 patients develop numbness or tingling lasting longer than 48 hours. 
  • For most people, numbness or tingling improves within 4 to 6 weeks after surgery. 99% of patients improve by 1 year. 
  • Numbness and tingling may not always be due to the block itself. It can be a complication of the operation or related to the position you lie in during the operation. It can also be related to the use of a tourniquet during the operation (a tight band on the arm that prevents bleeding).
  • Permanent nerve damage is rare (1 in 5,000 patients).

Hoarse voice, droopy eyelid, mild breathlessness

  • These side effects may happen after we use a block in the neck (eg for shoulder surgery).  They are temporary and go away as the block wears off.

Rare risks

  • Bleeding
  • Infection at the injection site
  • Lung injury
  • Allergic reactions

How long the pain relief lasts

  • The nerve block usually lasts 12 to 24 hours.  It gives good pain relief during the immediate period after your operation, when pain is usually the worst.
  • As the block begins to wear off, it is usual to feel some temporary tingling. 

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Take some pain relief (as directed by your surgical team) before the block wears off and you feel pain.

What to do after your operation

Heavy arm While the block is working your arm will feel heavy and numb and will not move. You may need someone to look after you and help you dress.
Risks You will not be fully aware of your arm position. You may accidentally bump or twist your arm. Be careful of heat sources such as fires, radiators or hot drinks. You will not be aware of burning yourself.
Arm sling We will give you a sling to wear to protect and support your arm and shoulder until the block wears off.  Wearing the sling will help you avoid injuring your arm while it still feels heavy and numb.

When to seek further medical assistance

Go to your nearest A&E if you experience:

Unexplained breathlessness

or

Severe pain that is not controlled by your prescribed painkillers.

Telephone the on-call anaesthetists on 020 8546 7711 bleep 040 (24 hours) if:

The block has not fully worn off after 48 to 72 hours

or

You develop redness, swelling, severe pain or pus at the injection site.