Anaesthesia

 

Which anaesthesia is used for surgeries of a carpal tunnel syndrome?

 

Basically, several types of anaesthesia can be used for this surgery.

A very simple and less burdening possibility of anaesthesia for the surgery of a carpal tunnel syndrome is the median block. With this method, a local anaesthetic is injected “above” the median nerve. The area of the carpal tunnel is not sensitive to pain after about 10 minutes.

Also thumb, index finger and middle finger are becoming numb and tingle.

I perform a sole median block almost never, as I prefer the full elimination of the pain and additionally the elimination of every muscle activity within the arm. Therefore, the plexus anaesthesia has proved to be succesful in my experience (see below). The median block can be useful if the pain elimination is not quite complete with the plexus anaesthesia.

 

Should the surgery not better be performed with a general anaesthesia?

A general anaesthesia is basically possible for surgeries of the carpal tunnel syndrome. I personally prefer the plexus anaesthesia, as even after many hours after the surgery a good pain elimination can be achieved. Additionally, the patient can eat and drink shortly after the surgery.

 

What does the term “plexus anaesthesia” mean?

With this type of regional anaesthesia, an anaesthetic is injected near a plexus  in the shoulder area.

The arm plexus (plexus brachialis) is a network of bigger nerve trunks, which lead from the lower neck area to the armpit under the sollarbone.

The anaesthesia takes place in the course of this big nerve path.

With the plexus anaestheisa (correct: arm-pleus-anaesthesia) a plexus (arrow) in the area of the shoulder and the armpit is anaesthetised with a local anaesthetic. In most cases the whole arm and the hand is numb after arounf 30 minutes and not actively moveable.

Usually the plexus anaesthesia is performed in the armpit. In the clinic and the medical practice, this kind of anaesthesia is just called Plexus.

The doctor injects a anaesthetic into the armpit. The most common injection site with the aneasthetic of the arm (Plexus) is the armpit.

For surgeries on the hand, foream and ellbow, the injection of the anaesthetic into the armpit is enough (illustration above).

 

What is the advantage of the plexus anaesthesia on the hand or the forearm?

The surgery for fixing and plating of a wrist fracture need to be performed in a bloodless surgical field.

This significantly lowers the risk of injuring nerves or blood vessels. Only with this measure, the surgeon has the necessary sight to operate pecisely.

To avoid bleeding during the surgery of a fracture of the distal radius, a cuff is attached onto the upper arm. (similar to measuring the bllod pressure).

Like the blood pressure cuff, the ischemia cuff is inflated and an unpleasent pressure occurs at the upper arm. This pressure remains for the whole duration of the surgery! With the plexus anaesthesia, this cuff pressure is not felt.

This stunning method is less oneous compared to a general anaesthesia. Patients esteem especially that they can eat and drink directly after the surgery. From a medical point of view it is remarkable, that this type of anaesthesia remains for several hours after the surgery. Thereby, the time after the surgery can be bridged without further painkillers.

On request, a mild sleeping aid can be injected with this anaesthesia, so the patient oversleeps the surgery – without being under anaesthesia!

With all types of anaesthesia which stun the arm, this cuff pressure is not felt or hardly felt during the surgery! Therefore, a lot surgeons prefer a plexus anaesthesia for the surgery of a carpal tunnel syndrome. In rare cases, an anatomical peculiarity or a tumour is found in the carpal canal. Especial in such situations – but also with complications during the surgery – a good sight (ischemia) and a full pain elimination are of great importance.