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A guide to awake shoulder and hand surgery

What is a nerve block?

A nerve block is a local anaesthetic injection near the nerves that control your arm. This stops pain signals during surgery, keeping your arm numb, heavy, and tingly but pain-free.

How long does it last?

  • Numbness: Up to 24 hours
  • Some areas: Up to 48 hours
  • “Pins & needles” sensation: Normal as feeling returns

Optional sedation

If you’d prefer to be more relaxed or sleepy, sedation can be used alongside the nerve block. Discuss your options with the anaesthetist before surgery.

Why choose regional “Awake” anaesthesia?

  • Fewer side effects: Avoids common side effects of general anaesthesia, like drowsiness, nausea, and sore throat.
  • Faster recovery: You can eat, drink, and go home sooner – especially beneficial for diabetes patients.
  • Safer for some conditions: A better option if you have heart or lung conditions, as it places less strain on the body.
  • Interactive experience: If you’re having keyhole surgery, you might be able to watch your procedure on a screen (totally optional!).

Are there any risks?

Nerve blocks are generally very safe, but some risks exist.

Common and mild (temporary)

  • Incomplete numbness: May need extra anaesthetic or, rarely, a switch to general anaesthesia (1 in 20 cases).
  • Minor side effects: Hoarseness, droopy eyelid, mild shortness of breath (1 in 10 cases, resolves in hours).
  • Injection site effects: Mild bruising or bleeding (common but harmless).

Rare but possible

  • Nerve Irritation: Temporary Tingling/numbness that usually resolves within weeks or months. (Permanent: 1 in 2,000 to 1 in 5,000 nerve blocks).
  • Lung Air Leak (Pneumothorax) – Very rare if injected near the collarbone (less than 1 in 1,000 cases); may require treatment.

Extremely rare (Emergency Situations)

  • Serious reactions: If anaesthetic enters the bloodstream, it can cause dizziness or seizures (less than 1 in 10,000 cases), which your anaesthetic team is trained to handle immediately.Your anaesthetist will discuss these risks and answer any concerns before the procedure.

What happens during the nerve block?

You’ll be taken to a pre-surgery room

A cannula (thin plastic tube) will be inserted in your other arm for medication.

The injection site (neck, collarbone, or armpit) will be cleaned and numbed.

Using ultrasound guidance, the anaesthetist will inject the nerve block.

The block takes 20–40 minutes to fully work.

Sensation will be tested before surgery begins.

Most people say the injection feels no worse than a regular needle.

What happens during surgery?

  • A screen will be placed so you don’t see the procedure.
  • Music Option: Ask if you can use headphones during surgery.
  • Sedation Option: If used, you’ll feel relaxed & sleepy with little or no memory of the surgery.
  • You’re never alone! A member of the anaesthetic team stays with you throughout.

Aftercare and going home

What to expect

  • Your arm will feel heavy & weak for up to 48 hours.
  • Normal “pins & needles” as the block wears off.
  • You may need help with daily tasks.

Take care

  • Avoid heat. Don’t touch fires, radiators, or hot water – you won’t feel burns.
  • Be careful with appliances. No kettles, irons, or cooking until sensation returns.
    Take pain relief early. Before numbness wears off to avoid sudden pain.

When to seek medical help

  • Unexpected breathlessness
  • Severe pain that doesn’t improve with medication
  • Numbness lasting over 48 hours

Contact

  • If your operation was at Stoke Mandeville Hospital:
    • Call 01296 315262 (9am–4pm).
    • Out-of-hours: Call 01296 315000 and ask for the on-call anaesthetist.
  • If your operation was at Wycombe Hospital:
    • Call 01494 426525 (9am–4pm).
    • Out-of-hours: Call 01296 315000 and ask for the on-call anaesthetist.

Frequently asked questions

Can I eat before surgery?
NO Follow fasting instructions in case general anaesthesia is needed.

Do I have to stay awake?
NO You can choose sedation if you prefer. If you have sedation or a light anaesthetic, someone must accompany you home and stay with you for 24 hours.

Further information

Visit the Royal College of Anaesthetists website www.rcoa.ac.uk
and search “For Patients and Relatives”

Watch this video on nerve blocks: https://www.youtube.com/watch?v=GEId1b2_KSw

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