At COMA 2017
Presenting at COMA 2017 in Terrigal, New South Wales, on handling the complications of anaesthetic blocks.
What an anaesthetic block is
A regional block is an injection of local anaesthetic placed near the nerves that supply a limb, so that the limb is numbed for surgery and for a period afterwards. For shoulder and upper limb operations the relevant nerves run in the brachial plexus, the bundle that passes from the neck into the arm. Blocks are used widely because they reduce the amount of general anaesthetic needed and provide pain relief once the patient has woken. Individual results vary, and the choice of anaesthetic is made by the anaesthetist with the patient before surgery.
Rare, but worth planning for
Complications of anaesthetic blocks are exceedingly rare. That is worth stating plainly, because a talk on the subject can give a misleading impression of how often they occur. The reason for discussing them is not that they are common but that when a nerve injury does occur, knowing what can be done about it matters a great deal to that person.
That is also why the subject belongs at a combined orthopaedic and anaesthetic meeting. The anaesthetist places the block and the surgeon is often the person who sees the patient afterwards, so recognising a nerve problem early and knowing where to refer it depends on both groups understanding the same ground.
Nerve transfer
Nerve transfer techniques have been developed for many serious nerve injuries. The principle is to take a working nerve, or part of one, that supplies a less important function, and redirect it to restore a more important one. These techniques have expanded what can be offered for injuries that were previously considered untreatable. Individual results vary and depend on the nerve involved, the nature of the injury and how soon it is addressed.
Timing counts because a muscle cut off from its nerve supply gradually loses the ability to respond, and a nerve has to grow along its new path before it reaches the muscle it is being asked to drive. Connecting a healthy nerve close to its target shortens that journey, which is the main advantage of a transfer over a graft at the original injury.
Congratulations to the organiser Ed Bateman, and thanks to Bec Fielding.
Related information
- Our post on when blocks go bad, from the same conference.
- Shoulder surgery
- Surgery FAQs
- Consultation