Hand surgery, while patients are awake

Patients at The James Cook University Hospital can now undergo hand surgery while they are awake.

Trauma experts at the Middlesbrough Hospital have been piloting a new hand block service which uses local anaesthetic to numb the nerves so patients can stay awake to watch their operation and chat to their consultant throughout the procedure.

As patients do not have to be put to sleep there is less risk of nausea, vomiting and the complications associated with having a general anaesthetic. It also means patients can go home, and eat and drink, immediately afterwards.

The nerves can be temporarily numbed above the collar bone, below the collar bone or in the arm pit - an ultrasound machine is used so the team can see precisely where the injection is going.
“In the past some patients had to stay overnight, but now we can get them home straight after the procedure and follow them up with a phone call two days later,” said hand and plastics surgeon, Anna Barnard. “They should have the full feeling back in their arm four to 24 hours later.”

As well as being better for patients it also frees up theatre recovery beds and there are significant savings in terms of nursing costs.

Consultant anaesthetist Patrick Chiam added: “People are surprised to be offered the nerve blocks, but most are happy to try it. The service is already receiving 98% patient satisfaction rates and our staff are really enthusiastic about it too.”

David Dixon, 38, was one of the first to undergo hand block surgery at The James Cook University Hospital.

The investment manager from Ingleby Barwick injured his finger during a goalkeeping save which saw it swell to twice its normal size. At first he thought nothing of it but was shocked to discover he needed an urgent operation. 

“I was a little bit nervous about going under general anaesthetic and said I would prefer a local anaesthetic - as luck would have it they were about to start the hand block surgery,” he said.

“The actual operation was quite surreal. It was weird having someone operate on you while you were talking to them.

“The team made me feel very comfortable, they were chatting to me and having a laugh with me. I was so relaxed that my blood pressure and heart rate barely increased.

“It was great because I wanted to get home and be comfortable in my own surroundings. Plus I didn’t want to take up a bed when I only had an injured finger. I also liked the thought of not losing control.

“I went into theatre at 9.30am, was home by 12.30pm and was picking the kids up by 3.30pm!”
David described the service he received as ‘astounding’, adding: “I had complete trust in my surgeon Anna Barnard, she was very professional, very caring and soon put me at ease.”

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