Anaesthesia during surgery of de Quervain disease

 

What kind of anaesthesia is necessary for the surgery of a tenosynovialitis (de Quervain)?

A general anaesthesia is rarely necessary fo the surgery of a de Quervain tenosynovialitis! Most surgeons (surgeons, hand surgeons, orthopedic surgeons) prefer some form of nerve blockage:

What options are available?

For the surgery of a de Quervain disease (tenosynovialitis at the forearm), it is possible to anaesthesize the radial nerve (so called radial block) or the whole arm is anaesthesized with a plexus anaesthesia.

 How is the blockage of the radial nerve (radial block) performed?

In the illustration, the radial nerce (the superficial branch if the radial nerve, to be more precise) is marked yellow. If local anaesthesia are injected at the nerves in the area of the blue arrows, the pain perception is disabled in the are of the skin incision (red arrow).

The illustration shows the performance of a radial block during a surgery.

The radial blockage was necesary in additional, as the plexus anaesthesia had an effect, but discomforts remained with the skin incision.

Why the  local anaesthesia is not injected directly in the surgical area?

The  local anaesthesia itself, but also small bleedings due to the injection, can impair the exact view in the surgical field. This increases the danger of an accidental injury of the radial nerve or some of ist branches.

What is the disadvantage of a nerve block at the hand or the forearm?

Most surgeons prefere to  performed the operation in a bloodless surgical field.

This significantly lowers the risk of injuring nerves or blood vessels. This especially true for the branches of the radial nerve, which are superficially cross through the surgical field.  These nerve branches  can be easily injured due to a poor view in the surgical field.

To prevent bleeding during the surgery of the 1. extensor tendon section (at the narrowed canal), a cuff is applied on the upper arm (similar to measure the blood pressure).

As with the blood pressure cuff, the bloodless cuff is pumped up and an uncomfortable pressure occurs at the upper arm.

With all anaesthetic forms which only anaesthesize the nerves on the forearm or the hand, this uncomfortable pressure from the cuff is disturbing during the surgery!

Therefore, many surgeons prefer a plexus anaesthesia also for surgeries if snapping fingers or thumbs or de Quervains disease.

What means the term: plexus anaesthesia?

With this form of regional anaesthesia, a narcotic is injected nearby a plexus in the schoulder area.

The arm plexus (brachial plexus) is a plexus if large nerve trunks, which lead from the lower neck area under the collarbone to the arm pit.

In the course of this large nerve path, the anaesthesia takes place.

With the plexus anaesthesia, the shoulder, arm and hand is anaesthesized with a local anaesthetic. In most cases, the whole arm and the hand is numb and immobilized after about 30 minutes.

The most common plexus anaesthesia if performed in the armpit. In hospitals and the medical practice, this form of anaesthesia is just called Plexus.

The anaesthetist inject the anaesthetic into the armpit. The most common injection location with the arm anaesthesia (plexus) is the armpit.

For surgeries at the hand, forearm and elbow an injection in the area of the armpit if sufficient. It’s very valuable that the anaesthesia lasts for a couple of hours after the surgery. This significantly reduces the amount of anaesthetics, which need to be taken after the surgery of a surgery of a tenosynovialitis (de Quervain disease)!