Awake surgery has been around for many years, with some neurosurgery and several lower limb operations routinely performed with patients awake. Awake upper limb surgery under regional anaesthesia is a more recent development that is slowly growing in popularity. Most shoulder surgery is done with the patient in a sitting or “beach chair position”. During a general anaesthetic, the heart is required to pump blood against gravity while under the effect of anaesthesia, and therefore strokes are a rare but devastating possibility.
Modern developments in regional anaesthesia and the increasing use of ultrasound have allowed anaesthetists and surgeons to work together to perform safe, and comfortable awake shoulder and elbow surgery. Awake shoulder and elbow surgery isn’t right for all procedures, all patients, all anaesthetists, or all surgeons. Safe and effective awake surgery requires an expert team of surgeon and anaesthetist who are both enthusiastic about awake surgery, the correct patient selection, and the appropriate surgical procedure.
Why bother with awake shoulder and elbow surgery some may ask? There are multiple benefits for the patients. Firstly it is safe and avoids many of the risks of general anaesthesia, the nausea that some patients experience after a general anaesthetic can be completely avoided, and recovery is quicker with better post-operative pain relief and quicker discharge from hospital.
I am enthusiastic about awake shoulder and elbow surgery and work with anesethetists who are experts and enthusiasts in regional anaesthesia. In addition to the safety benefits above, I think my patients, especially those undergoing shoulder arthroscopy, benefit from being able to see inside their joint and understand their anatomy, their condition and the treatment performed. While some patients worry that it may be gory, I can assure them that it is nothing of the sort and over my time during awake shoulder and elbow surgery I have often heard patients who refused to watch ask, “what is that you’re doing there?”
The insight gained into understanding their condition and surgery means the patient can be more confident working with their physiotherapists during rehabilitation and this can only be good for recovery.
I encourage my patients to consider awake surgery and my team and I work to ensure that it is a safe and comfortable experience, with discomfort kept to a minimum and anxiety compassionately managed. It is worth enquiring of your surgeon whether awake surgery is right for you!
Mr. Nick Ferran, Consultant Shoulder & Elbow Surgeon
Clinics at Chelsea Outpatient Centre
Appointments: 020 7164 6312