Nerve blocks for surgery on the shoulder, arm or hand

Nerve Blocks for Surgery on the Shoulder, Arm or Hand

Patient Information

Anaesthetics

• Author ID: MH
• Leaflet Ref: Ana 001
• Version: 4
• Leaflet title: Nerve blocks for surgery on the shoulder, arm or hand
• Last review: May 2025
• Expiry date: May 2027

Having a nerve block for your operation

For your operation, you may be offered a type of anaesthetic called a “nerve block”. A nerve block is an injection of local anaesthetic around nerves that makes your arm (or part of it) numb. This is a safe and effective type of anaesthesia. Nerve blocks can be combined with general anaesthetic to provide pain relief after the operation, or they could be used as an alternative to general anaesthetic. Your anaesthetist will explain to you everything that is involved in having a nerve block.

What are the benefits of having a nerve block?

• Better pain relief after surgery, which can last between 6 and 24 hours.
• Less need for strong painkillers which may cause drowsiness / sickness.
• Shorter recovery period.
• General anaesthetic may be avoided, with its side effects including sickness, drowsiness and sore throat. You will be able to eat and drink immediately after surgery.
• Often able to leave hospital sooner.

What are the side effects/risks?

As with any procedure, a nerve block is associated with risks, but serious complications are very uncommon. Some of the potential complications are listed below:

• Injection in the side of the neck: hoarse voice, droopy eyelid, some difficulty breathing. These resolve as the block wears off. 
• Injection around the collar bone: less than 1 in 1000 risk of causing a collapsed lung. 
• All injection sites: damage to a blood vessel which usually resolves with simple compression to stop any bleeding. 
• Very rarely: having a fit or another life-threatening event may occur. Your anaesthetist will manage these promptly. 

• Nerve damage (causing arm numbness or weakness): 
  • There is a risk of nerve damage after any operation, regardless of whether you have had a block. This can be due to the operation, the position you lie in or the use of a tourniquet (tight band on the arm which prevents bleeding during the operation). 
  • The risk of long-term nerve damage caused by a nerve block is difficult to measure precisely. Studies show that it happens in between 1 in 700 and 1 in 5,000 blocks. 
• Incomplete block:
  •  Sometimes the block does not work fully. Your anaesthetist will deal with this appropriately. You may be offered an extra injection of local anaesthetic or a different type of anaesthesia / pain relief.

How is the nerve block performed? 

• The injection site can be either at the side of your neck, near your collar bone or under your armpit, depending on the type of surgery.
• An ultrasound scanner is used to view the nerves. 
• The injection site will be cleaned and local anaesthetic given to numb the skin, before more is injected to surround your nerves.
• Sometimes a nerve stimulator is used, which feels like a gentle twitching.
• Your shoulder and arm will gradually become heavy and numb over about 15-30 minutes.
• If you are having a general anaesthetic as well, this may be given before or after the nerve block. Your anaesthetist will advise you.

Having an operation under a nerve block only

Your operation will not start until your anaesthetist is sure that the block is working effectively. You will have the option to remain completely awake or to receive sedation to feel more relaxed and drowsier. A member of anaesthetic staff will stay with you all the time. During surgery it is normal to feel some movement or touch, but you shouldn’t feel any sharp discomfort or pain. If you do, please let a member of staff know so that it can be immediately dealt with.

What will happen after the operation?

• During the time the block is working, your arm will be numb, and you will not be able to use it. This is usually between 6 and 24 hours, occasionally longer.
• Keep your arm in the sling provided.
• Do not sleep on your anaesthetised arm.
• Avoid use of any machinery or domestic appliances, be careful around heat sources – injury is possible while you cannot feel your arm.
• The numbness will eventually wear off and the sensation in your hand or arm will return – you may get a pins-and-needles sensation in your arm as the anaesthetic wears off.

You need to start taking regular painkillers before the block wears off (in the afternoon and before bed) – this is very important as the pain can appear quite suddenly.

Any further questions

Your anaesthetist will be happy to answer any questions you have.

Reference

The following website can give you more information: www.rcoa.ac.uk/patientinfo  - see leaflet about nerve blocks for surgery on the shoulder, arm or hand.