Nerve Blocks for Shoulder, Arm and Hand Surgery

This leaflet is aimed at anyone undergoing arm or hand surgery who is thinking about having a nerve block for their operation. Often this is done instead of a general anaesthetic.

What to expect

A nerve block is a type of anaesthetic or pain relief frequently used for surgery on the arm or hand. It involves the careful injection of local anaesthetic around the nerves that provide sensation to this area to make them numb for surgery. The injection can be in your neck, around your collar bone or armpit or further down your arm. 

What are the benefits of having a nerve block?

  • Excellent pain relief during and after surgery and less need for strong pain medicines which can make some people feel drowsy or sick
  • Avoid a general anaesthetic and its associated risks and side effects
  • Can often recover quicker and leave hospital sooner
  • Fewer side effects than with a general anaesthetic

What does a nerve block involve?

Nerve blocks are performed by anaesthetists trained in the technique and they will discuss the procedure fully with you. A small intravenous line (drip) is placed in the hand or arm not being operated on and other routine monitoring is attached.

First, the skin is cleaned and then made numb with a small amount of local anaesthetic. A fine needle is then carefully guided towards the nerves using either an ultrasound machine or a nerve stimulator – a small machine which makes your muscles briefly twitch. More local anaesthetic is then injected around the nerves to ‘block’ them. Most people find that the injection is no more painful than having an intravenous drip inserted but sometimes sedation can be used.   

Sedation can be given before the injection is done to help you relax. Your hand and arm will start to feel warm, tingly and heavy soon after the injection. Your anaesthetist will carefully check the block before surgery starts. Occasionally a top-up of local anaesthetic is needed to ensure the block is complete.

During your operation

A screen will be placed so that you cannot see the operation, unless you want to. A member of staff will be available to answer any questions and ensure you are comfortable. Before surgery, a tight band (tourniquet) will be wrapped around the top of your arm. This helps prevent bleeding in the area of surgery. When the operation starts it is normal to sometimes feel some movement or touch but you should not be able to feel any discomfort or pain. An iPad will be offered to you to watch or listen to music throughout your operation.

If you prefer, sedation can be provided instead which, while you remain conscious, will make you relaxed and sleepy. Occasionally it will be planned for you to have a general anaesthetic in addition to the nerve block. This depends on the type and length of your operation and this will be fully discussed with you beforehand.

After your operation

Your hand and arm may remain numb, with reduced power and movement, for 4 to 24 hours depending on the type of block performed. Your arm will need to be supported in a protective sling until the sensation and movement has returned to normal. It is important that you take care of your arm while numb and avoid contact with sources of hot or cold. 

As the block wears off your arm may again feel tingly with pins and needles. Strength will slowly return. It is important that you have started taking the tablet pain medicines supplied to you by this time, so that you are comfortable when the block wears off. 

  • Occasionally a block will not work well enough for your operation and a general anaesthetic may be required. In this situation the block may still provide good pain relief afterwards although, if necessary, other pain medicines can also be used to keep you comfortable. 
  • There is a small risk of nerve damage after any operation regardless of the type of anaesthetic used. This is due to the operation, the position you lie in or the use of a tourniquet. Swelling around the operation site or other medical conditions such as diabetes may also lead to nerve damage.
  • The risk of long term nerve damage following a nerve block is approximately 1 in 5000 cases. The risk varies between different blocks. About 0.5% to 1% of patients may notice a prolonged patch of numbness, tingling or weakness in the affected area (lasting > 48 hours postoperatively). This will get better in 95% of patients within 4-6 weeks, and in 99% within a year.
  • Other emergency problems, such as seizures or heart problems, are very rare. Your anaesthetist is trained to deal with these emergencies.

Questions you may like to ask your anaesthetist

  • Who will carry out my injection?
  • Do I have to be awake?
  • What happens if I can feel something?
  • When will my arm start to feel normal again?
  • Will someone stay with me during my operation?
  • Who should I call if I am worried about the effects of the block after surgery?

Helpline

If you have any issues or concerns, about your anaesthetic, after your operation please contact:
Anaesthetic Department: 0117 414 5114 (Mon-Fri, 9am to 5pm)    

For pain that is not controlled by your tablets, please go to the Emergency Department.

References

NHS Constitution: Information on your rights and responsibilities

Royal College of Anaesthetists: Patient Information Publications 

Published September 2020. Review due September 2022 NBT002867

Nerve Blocks for Shoulder, Arm and Hand Surgery