What are the benefits of local anesthesia?
Local anesthesia eliminates pain in the surgical field without any loss of consciousness. If needed, it may be combined with sedation in order to induce a state of somnolence. For more painful procedures, we carry out long term local anesthesia with or without a nerve block catheter. Perineural catheters make it possible to continue injecting local anesthetics during hospitalization. These modern techniques allow for comfortable, high quality postoperative analgesia. Our team’s extensive experience in local anesthesia (8,000 cases per year) allow us to carry out such techniques while minimizing risk.
Is local anesthesia painful?
Not much or not at all! Anxious patient can be given a relaxing medication before anesthesia.
How long does anesthesia last?
Depending on the type of product used, the anesthesia may last from 2-3 hours to 12 hours.
What are the risks of local anesthesia?
A risk of hematoma at the puncture site exists, especially when the anesthesia is performed in the axillary fold. Anti-blood-clotting medications (which thin out the blood) may favor such hematoma, which most often disappear with no sequelae.
Shoulder local anesthesia may exceptionally generate temporary (just a few hours) eye discomfort, with a slight drooping of the eyelid, as well as a feeling of respiratory discomfort.
local anesthesia of a limb involves few risks. However, minor neurological disorder are observed in 0.4% of cases (> 72h). This incidence is probably overestimated nowadays, as rapid progress has been made in nerve localization techniques. At the Institut de la Main, nerve localization has been carried out with ultrasound technology since 2007, when neurostimulating techniques were abandoned. The wide majority of neurological lesions are temporary and subside within one month.
More serious complications related to the passage of anesthetics into the blood during the injection may cause agitation, convulsions, and, very rarely, cardiac disorders.
What are the risks of general anesthesia ?
The main drawbacks of general anesthesia are nausea and vomiting upon waking up. Thanks to preemptive drug treatments, these drawbacks have become less frequent. Incidents related to the issue of vomiting into the lungs are extremely rare as long as the fasting guidelines have been followed.
The introduction of a tube in the trachea (intubation) or in the throat (laryngeal mask airway) in order to insure breathing during anesthesia may lead to sore throat or to temporary hoarseness. Dental trauma may also occur. It is important for the patient to notify the physician of any dental prosthesis, pivot tooth or dental fragility. In some cases, a dental checkup might be required beforehand.
Painful redness of the vein where the product was injected may be experienced and should disappear within a few days.
The patient’s position on the operating table may lead to the compression of certain nerves, therefore causing numbness or, exceptionally, paralysis of a limb. In most cases, these deficits disappear within a few days to a few weeks.
Temporary memory disorders and an inability to focus may be experienced in the hours following anesthesia, especially in older patients.
Unforeseeable life threatening complications, such as severe allergies, cardiac failure or asphyxia, are extremely rare. Approximately, severe complications happen at the rate of one per hundreds of thousands of anesthesias.
For any type of procedure, the axillary block technique is the safest type of arm anesthesia available. In addition, it allows for adequate postoperative pain management. After light sedation, the patient's arm is numbed thanks to local anesthetics which are injected near the nerves.
We carry out two puncture methods: either near the clavicle (supraclavicular block), under the armpit (axillary block and humeral tunnel). The goal is to inhibit the major arm nerves: the ulnar nerve, the radial nerve, the median nerve and the musculocutaneous nerve, which are in charge of arm sensation. In most cases, we perform a complete anesthesia of the arm and forearm. For distal and very localized procedures (fingertip), we perform the anesthesia closer to the surgical field.
For shoulder surgery, when there are no contraindications, we systematically carry out an interscalenic block anesthesia first. We numb the nerves that are in charge of shoulder sensation thanks to a puncture near the neck. A catheter is placed near the nerves, and left in place for 48 to 72 hours, which allow us to treat postoperative pain efficiently. In some cases, the catheter is replaced by a single injection of long-acting anesthetics, therefore allowing for a 12 to 18 hour postoperative analgesia. In almost all cases, we combine this local anesthesia with general anesthesia.
Except for emergency procedures, patients must make an appointment with an anesthetist before being admitted. This mandatory consultation must take place several days before the scheduled procedure.
Anesthesia Office
12 rue Chaillot - 75116 Paris
Phone : +33(0)9 73 01 98 15
Patients must have an empty stomach prior to surgery (see pre-operative fasting section). After a Betadine shower, patients will put on a single use gown. All jewelry (wedding rings, necklaces, rings, piercings…) must be left in the room, along with any dental prostheses and hearing aids unless otherwise stated by the medical team.
Patients should not wear makeup or apply any facial lotion on the day of surgery. Similarly, men are encouraged to shave their beards. Should general anesthesia be performed, makeup, lotion and beards may complicate the intubation process.
Patients are then taken to the operating room depending on the schedule of their procedure. There, the anesthetist working with the physician (who may not be the same anesthetist whom the patient met for the anesthesia consultation) will greet you. The patient's medical file will be checked. Unless contraindicated, a catheter will be fixed on the contralateral arm. Anxiolytics (anti-anxiety drugs) will be administered to the patient.
Local anesthesia is carried out in a dedicated space. Nerve localization is performed thanks to an ultrasound machine. A dose of local anesthetics is administered near each of the patient’s nerves in order to lose any sensation in the limb undergoing surgery. Depending on the procedure, the anesthesia will last either 4 hours (with Xylocaïne) or 12 to 24 hours (with Naropeïne). The implementation of the anesthesia takes less than 15 minutes.
If indicated, general anesthesia is performed in the operating room.
After completion of the procedure, the patient is taken to the “post-anesthesia care unit” (recovery room). Once the pain has dissipated, that there is no sign of nausea or vomiting or of bleeding and that the patient’s condition is similar to that pre-anesthesia, he or she is taken back to one’s room.
When the procedure is compatible with quickly returning home, patients are admitted in the day surgery unit. Outpatient procedures are carried out in the morning or in the afternoon. Patients must arrive with an empty stomach (see pre-operative fasting section). They are installed in a small private room, where they undress and put on a single-use gown. All jewelry (wedding rings, necklaces, rings, piercings…) must be left in the room, along with any dental prostheses and hearing aids unless otherwise stated by the medical team.
Patients should not wear makeup or apply facial lotion on the day of the procedure. Similarly, men are encouraged to shave their beards. In fact, in cases of general anesthesia, makeup, lotion and beards complicate the intubation process.
Patients are then taken to the operating room depending on the schedule of their procedure. There, the anesthetist working with the physician (who may not be the same anesthetist whom the patient met for the anesthesia consultation) will greet you. The patient's medical file will be checked. Unless contraindicated, a catheter will be fixed on the contralateral arm. Anxiolytics (anti-anxiety drugs) will be administered to the patient.
Local anesthesia is carried out in a dedicated space. Nerve localization is performed thanks to an ultrasound machine. A dose of local anesthetics is administered near each of the patient’s nerves in order to lose any sensation in the limb undergoing surgery. Depending on the procedure, the anesthesia will last either 4 hours (with Xylocaïne) or 12 to 24 hours (with Naropeïne). The implementation of the anesthesia takes less than 15 minutes.
If indicated, general anesthesia is performed in the operating room.
After completion of the procedure, the patient is taken to the “post-anesthesia care unit” (recovery room). Once the pain has dissipated, that there is no sign of nausea or vomiting or of bleeding and that the patient’s condition is similar to that pre-anesthesia, he or she is taken back to the outpatient unit.
In the outpatient unit, patients are given a snack and their IV is removed. After putting their clothes back on, patients will only be allowed to leave the hospital with a friend or family member. In case of postoperative complications (intense pain, nausea, vomiting), the patient might require to be hospitalized and therefore won’t be discharged the same day.
Patients will be given a prescription for analgesics (pain killers) by their anesthetist.
In 20 years of existence, the INSTITUT DE LA MAIN has become one of the main hand and upper limb surgery centers in Europe. Its nine surgeons on staff can treat all hand and upper limb problems.
Institut de la Main
Clinique Bizet
21 rue Georges Bizet
75016 PARIS
Front Desk : +331 84 13 04 56
Hand Emergencies : +331 84 131 131
