ROTATOR CUFF REPAIR SURGERY
ANAESTHESIA AND PAIN RELIEF FOR ROTATOR CUFF REPAIR SURGERY
Rotator cuff repair surgery involves a full general anaesthetic and usually an additional form of pain relief called a nerve block. This type of surgery can be painful to recover from and the nerve block has been found to be very useful in relieving this pain in the first 12-24 hours after surgery. I use an ultrasound device to locate the nerves in the neck and when you are asleep I carefully inject some local anaesthetic around these nerves to send them to sleep for 8-16 hours. The effect of this injection is to render the shoulder partially numb and comfortable. Other effects include some pins and needles and weakness of the arm and hand. The whole arm may go completely numb for a period of time but this is fully reversible and uncommon. Prolonged numbess of a patch of skin in the arm or hand lasting longer than 1-2 days is possible in a small percentage of patients but the majority will completely resolve over a few weeks. This may result from the effects of the surgery, your positioning during the operation or from the nerve block itself. Serious nerve injury resulting in weakness of the arm or hand is very rare.
The nerve block will "wear off" sometime after 8-12 hours. At this time the shoulder may start to become uncomfortable and you are likely to need quite strong additional pain relief. I will have used some anti-inflammatory injections and also given you a slow release PALEXIA tablet soon after your operation to help with managing this pain. Usually this results in a gradual offset of the nerve block and manageable pain. However occasionally it may be more severe. Please call your nurse if you are in any significant discomfort for additional pain tablets. Quick onset PALEXIA are available every 2 hours.
CONTINUOUS NERVE BLOCK FOR SHOULDER OPERATIONS
Some patients will be offered a continuous nerve block technique where a small plastic tube is placed next to the nerves of the shoulder to provide sustained pain relief for several days. The tube will be connected to a small portable pump that will supply local anaesthetic to the area. This results in a partially numb shoulder with reduced pain signals. Anticipated effects from this include less pain but also some weakness of the muscles of the shoulder. This may also include numbness and weakness of the arm and hand as all the nerves are close together. The usual plan is to run the infusion at a low does to provide pain relief and reduce the effect on the muscles. With this approach the infusion may need to be “topped-up” from time to time. It will be typically programmed to provide ~2mls per hour as a background rate and then if you need a top up you press the top-up button (see link below) and an additional 5 mls will be administered. This top up function will be available every 4 hours. This can be useful at night for example where more pain relief is helpful while having a slightly more numb arm is not a problem. The infusion can continue for up to 5 days after your surgery. The benefits of continuing the infusion for this period is better pain relief and reduced need for strong pain medications, which can have unpleasant side effects.