I had regional anesthesia (axillary block) but felt the surgeon slice open my thumb (painful!) is this normal?

Question

I had surgery to reconstruct a ligament on my thumb. The surgeon, anesthesia dept. and I all agreed on an axillary block the week before surgery. The day of surgery I was assigned a Nurse Anesthetist who was not qualified to perform one. It was only when the surgeon told him I wanted the block that the Nurse aneshetist went off to find an Anesthesiologist who could do one.

I watched the clock tick as he asked 3 Anesthesiologists before he found one who agreed to do it. At this point there was less than 30 minutes before surgery was to begin. The Anesthesiologist performed the block then asked me to touch my nose. I was able to bend my elbow but once I got past 9 degrees, I had no coordination and hit my face. The anesthesiologist pronounced the block successful and left. 10 minutes later I was wheeled into surgery. 10 minutes after that I felt the surgeon slice into my thumb. It really hurt. Shouldn't the anesthesiologist have done a sensory check on my hand?

Answer 1

You probably had a block that did not last enough through the surgery.  That is strange that they didn't provide proper pain management to you.  Did you tell the surgeon that you had sensation and pain?  S/he should have stopped right away and taken care of your well-being first.  You should talk to them and the insurance, and perhaps even an attorney.  I'm not sure what kind of place you had the surgery (a hospital, a day-surgery place?), what ever it was, they sound quite unprofessional!

Answer 2

I hate axillary blocks.  Even in the best of hands, there is a significant failure rate.  They take forever to set up - 45 minutes or more is not uncommon.  It's very easy for nerves to get missed.

It would have been a good idea on the part of the anesthesiologist to poke you with a needle at the incision site.  Best test to see if the right area is numb.  If an area is missed, the surgeon can usually inject a little extra local where s/he is working.

Still, if you took the time to work this out ahead of time, the anesthesia department should have noted that and made an appropriate assignment. That was unprofessional.  There's usually one anesthesiologist in every department that's a regional anesthesia nut, and that's who should have done your case.