Pre-operative Information - Orthopaedic (Upper Limb)

| Preoperative Anaesthesia Assessment Clinic (PAAC)

Fasting Instructions

Remember to add this page to your Health Buddy ‘Favourites’ for easy access before your surgery. Simply click on the ‘star’ icon at the top right of Health Buddy app.

Before surgery

You will receive a phone call informing you of the time and location of your surgery.

Fasting instructions (VERY IMPORTANT)

Do not consume any food , juice, drinks with milk or carbonated drinks after midnight. This is to minimise the risk of aspiration, where food is regurgitated from the stomach and into the lungs. Water is the best option to keep yourself well hydrated.

No consumption of FOOD after midnight.
You are then only allowed to have WATER up to 6 am.
Ensure you drink 200ml of WATER at 6am.
No more WATER is allowed after 6am.

Fasting

Patient Information Sheet

On the day of surgery

You will report to either the Day Surgery or the Same Day Admission unit as instructed. After registration, you will be asked to change into a gown and see a doctor before entering the reception area of the Operating Theatres (OT).

Depending on your procedure, there is the option of a Regional Anaesthesia (RA) procedure for intra-operative and post-operative pain relief before you are brought into the OT for your surgery. General anaesthesia (GA) will then be administered and you will fall into a ‘deep’ sleep during the operation.

General Anaesthesia (GA)

General anaesthesia is a state of controlled unconsciousness during which you will feel nothing. It is almost like being in a ‘deep’ sleep.
Anaesthetic drugs will be injected into a soft plastic tube that has been inserted into a vein of your hand. This is to induce the state of ‘deep’ sleep.
These drugs stop your brain from responding to sensory messages travelling from the nerves in your body.
You will be unaware of your surroundings, the surgery or pain.
You will be asleep for the entire duration of the surgery and woken up only after the surgery is completed.
You will have no memory of the procedure.
Your anaesthetist and anaesthetic team will be with you during the surgery.

Common risks associated with GA

This will affect 1 in 10 to 1 in 100 patients who undergo surgery with GA.

Nausea and vomiting – due to the side effects of the anaesthetic drugs and type of surgery
Sore throat – due to the presence of the breathing tube used when you are asleep
Giddiness, headache or sleepiness – due to the remaining effect of the anaesthetic drugs
Aches (e.g. backache) or pain – due to your body posture during surgery
Experience pain when drugs are injected – due to the side effects of the anaesthetic drugs
Bruising and soreness – due to your body posture during surgery
Itch - due to the side effects of the anaesthetic drugs.

Uncommon risks associated with GA

This will affect 1 in 10,000 patients who undergo surgery with GA.

Eye abrasion causing pain and requiring treatment
Damage to teeth and dental work, lips or tongue
Injury to the skin, eyes or nerve due to your body posture during surgery.

Rare risks associated with GA

This will affect 1 in 10,000 to 1 in 100,000 patients who undergo surgery with GA.

Being aware of activities in the operating room while still under GA
Inherited muscle sensitivity to particular anaesthetic drugs (malignant hyperthermia). This can cause a rapid rise in body temperature, heart rate and breathing with high blood pressure and muscle rigidity.
Hoarseness of voice due to direct or indirect injury to the vocal cord.

Very rare risks associated with GA

Allergy to anaesthetic drugs causing wheezing, rash, swelling, low blood pressure, and poor circulation in severe cases
Heart attack (AMI - Acute Myocardial Infarction), stroke (CVA - Cerebrovascular Accident) and pneumonia
Brain damage or death.

Sedation

This involves injecting medication through a vein to keep you drowsy and comfortable while you are under Regional Anaesthesia (RA). You may or may not remember the procedure because of the sedation. You may wake up intermittently, but will usually fall back asleep after.

Regional Anaesthesia (Nerve block)

This is an injection of local anaesthetic near the nerves that supply the sensation and movement to your shoulder, arm or hand. Your arm will be numb and pain-free for up to 24 hours afterwards. You will not be able to move it properly during this time.
This procedure is usually conducted before surgery commences. You will be either awake or lightly sedated during the nerve block procedure.
Ultrasound technology or nerve stimulator can be used to help visualise the nerve.
This technique can be used solely or in combination with a General Anaesthesia or sedation.
A successfully working nerve block reduces the surgical pain by causing numbness and weakness over the blocked limb for up to 24 hours.
After surgery, if pain relief is required for a longer duration, the anaesthetist will discuss the option of inserting a tiny plastic tube for the local anaesthetic drug to be infused continuously to prolong the block for up to a few days.
There is always a chance that the nerve block might fail, at which point you will be given either intravenous or oral painkillers after the surgery.

Common risks associated with RA

This will affect 1 in 10 to 1 in 100 patients who undergo surgery with RA.

Aches, pain, backache, bruising or soreness – due to your body posture during surgery, or as a side effect of the anaesthetic drugs.

Very rare risk associated with RA

Seizures, irregular heart rhythm or other life-threatening events may occur.

Common risks associated with RA

This will affect 1 in 10 to 1 in 100 patients who undergo surgery with RA.

Nausea and vomiting – due to the side effects of the anaesthetic drugs and type of surgery.
Giddiness, headache or drowsiness – due to the residual effect of the anaesthetic drugs.
Aches (e.g. backache), pains – due to your body posture during surgery.
Experience pain when drugs are injected – due to the side effects of the anaesthetic drugs.
Bruising and soreness – due to your body posture during surgery and the side effects of the anaesthetic drugs.
Itch - due to the side effects of the anaesthetic drugs.
Shivering.

Very rare risk associated with RA

Seizures or other life threatening events may occur.

Nerve damage associated with RA

The risk of long-term nerve damage caused by a nerve block is difficult to measure precisely. Studies show that it happens between 1 in 250 and 1 in 5,000 blocks.

The lower the nerve block is performed on the arm, the less severe the nerve damage is.
About 1 in 10 patients may notice a prolonged patch of numbness or tingling in their arm. These symptoms will resolve in 95% of these patients within four to six weeks, and in 99% within a year.
There is a risk of nerve damage after any operation, regardless whether you have had a block. This can be due to the surgery itself, the position you lie in or the use of a tourniquet (a tight band around the upper arm to minimise bleeding). Swelling around the surgical site or a pre-existing medical condition, such as diabetes, may also contribute to nerve damage.

Complications associated with different types of nerve blocks

Injection in the side of the neck

Hoarse voice, droopy eyelid or some breathing difficulties. These resolve as the block wears off.

Injection around the collarbone

Less than 1 in 1,000 risk of damage to the lung membrane, causing breathing problems.

All injection sites

Damage to a blood vessel during the injection.

Post-Operative Care

You will be monitored closely in the Post Anaesthetic Care Unit (PACU) immediately after the surgery, to ensure that you are comfortable and fine before your transfer to the ward. You may be given extra medications to relieve pain or vomiting.