At COMA 2017
Speaking at the Combined Orthopaedic Anaesthetic Conference in Terrigal, New South Wales. The topic was "When Blocks Go Bad", concerning the anaesthetic blocks used for pain relief after surgery.
What a nerve block is
A nerve block is an injection of local anaesthetic placed around the nerves that supply a part of the body, so that the area becomes numb. For shoulder surgery the usual target is the brachial plexus, the bundle of nerves running from the neck into the arm, which is reached in the neck or just above the collarbone, generally with ultrasound guidance.
Blocks are used in shoulder surgery because the shoulder is one of the more uncomfortable joints to operate on and because that discomfort is concentrated in the first day or two. A block can cover that period with less reliance on strong oral pain relief, which has consequences for nausea, for alertness and for how soon rehabilitation can begin. Individual results vary, and the anaesthetic technique is chosen by the anaesthetist in discussion with the patient before surgery.
Why the complications of blocks concern surgeons
A block is performed by an anaesthetist, but its effects are frequently assessed afterwards by the surgeon, on the ward round or at the first postoperative review. A patient with a weak or numb arm after shoulder surgery presents a question that has to be answered: whether this is the expected effect of a block that has not yet worn off, a consequence of the block itself, or something arising from the operation. Telling those apart requires each specialty to understand the other's techniques and the ways in which they can fall short.
Why a joint conference
Nerve blocks are performed by anaesthetists and their complications are often managed by surgeons, so a combined meeting is the right setting to discuss them. It was useful to share experiences with colleagues from both specialties.
Combined meetings are also where the practical arrangements get settled: who reviews what and when, what is documented, and what is explained to the patient beforehand, which is the part that makes an unexpectedly numb arm far less alarming if it happens.
Related information
See also our post on surgical options for severe nerve injuries, from the same conference, and our post on pain relief after shoulder surgery, along with our surgery FAQs and brachial plexus exploration pages.