Patient Information Local Anaesthesia for Pain Relief after Shoulder Surgery Directorate of Anaesthesia PIF 1273/V2

This leaflet explains what to expect when you have an operation with a local anaesthetic (upper limb block). It is part of a series about anaesthetics and related topics written by a partnership of patient representatives, patients and anaesthetists. What is an upper limb block? This is an injection of local anaesthetic around the nerves in your neck that supply your shoulder joint. What are the benefits of local anaesthetic blocks? • They give better pain relief than other methods until they wear off. • They produce less nausea and sickness. Shoulder surgery can be painful postoperatively and pain-relieving tablets and injections may not be sufficient. • They produce less drowsiness. • You return more quickly to eating, drinking possibly with a shorter stay in hospital. What are the side-effects? • Breathlessness. The injection can temporarily weaken one of your breathing muscles, sometimes making you feel a little short of breath until the local anaesthetic wears off. • Hoarseness – some patients develop a hoarse voice or difficulty swallowing until the local anaesthetic wears off (the injection sometimes numbs the nerves supplying the voice box). • Blurred vision – some patients get slightly blurred vision and drooping eyelid for a few hours until the local anaesthetic wears off.

What are the complications? • Occasionally the local anaesthetic does not work as well as expected and you will need other pain-relieving tablets during and after the operation. • Temporary nerve damage can occur but is uncommon. • Permanent nerve damage is rare with this technique. • Pneumothorax (punctured lung) is a very rare complication. • Seizures (fits) are a very rare complication.

How is the injection done? To locate the correct nerves in your neck, the anaesthetist will use either a needle guided by an ultrasound machine or a special needle with a small electric pulse. The electric pulse will briefly cause the muscles in your arm to twitch (which, if you are awake, can be a little unpleasant) and when the anaesthetist has located the correct nerves with the position of the needle, he or she will inject some local anaesthetic. • It is generally done while you are asleep • It can be done awake or under sedation (which slightly reduces the chance of complications).

How long does it last? When you wake up your arm will feel very heavy and numb. This usually lasts between 12 and 24 hours. You will be given pain-relieving tablets to take as the local anaesthetic wears off. At the end of the operation your arm will be in a sling – keep this on until normal feeling and movement returns (or longer if advised by the surgeon). You will need to protect your arm from heat and injury until normal sensation comes back. Can anyone have an upper limb block? No. An upper limb block may not always be offered if the risk of complications is too high. For instance, if you are taking blood thinning tablets, have an infection in your neck or you are allergic to local anaesthetic agents. Do I have to have a block? It is your choice. You do not have to have a block. There are several alternative methods of pain relief with morphine that work well; injections given by the nurses or by a pump into a vein which you control by pressing a button (Patient Controlled Analgesia, ‘PCA’). You will also be able to take pain-relieving tablets by mouth. We usually manage to make people comfortable postoperatively but we are more successful when we use this injection of local anaesthesia.

Further Information Your anaesthetist will discuss this procedure with you before the operation and answer any further questions. Information about anaesthesia is available from the website www.youranaesthetic.info.

Author: Directorate of Anaesthesia Review Date: March 2014

The above information is available on request in alternative formats including other languages, easy read, large print, audio, Braille, Moon and electronically.