Name of the Procedure:

Anesthesia for all closed procedures on radius, ulna, wrist, or hand bones
Common name: Regional or Local Anesthesia for Upper Limb Fractures

Summary

Anesthesia for closed procedures on the radius, ulna, wrist, or hand bones involves administering medication to numb the area and manage pain during the procedure. This type of anesthesia ensures that the patient remains comfortable and pain-free while the healthcare provider manipulates and stabilizes the broken bones without making any surgical incisions.

Purpose

This procedure is performed to:

• Alleviate pain during the manipulation and reduction of fractures.
• Ensure comfort and immobility of the affected area.
• Allow the healthcare provider to realign bones and apply a cast or splint effectively.

Indications

• Fractures or dislocations of the radius, ulna, wrist, or hand bones that do not require open surgery.
• Severe pain in the affected limb due to injury.
• Patients needing bone realignment and stabilization for proper healing.
• Suitable for patients with stable fractures or those unfit for general anesthesia.

Preparation

• Patients are usually advised to fast for a certain period before the procedure, typically 6-8 hours if sedation is used.
• Disclose all medications and allergies to the healthcare provider.
• Pre-procedure assessments may include X-rays or other imaging studies to evaluate the fracture.

Procedure Description

1. Consultation & Consent: The procedure begins with a detailed discussion with the patient about the anesthesia process, risks, and benefits, followed by obtaining informed consent.
2. Positioning: The patient is comfortably positioned to provide optimal access to the fracture site.
3. Anesthesia Administration:
   • Regional Anesthesia: An anesthetic agent is injected near a cluster of nerves to numb a larger area of the arm.
   • Local Anesthesia: An anesthetic agent is injected directly into the tissue around the fracture site.
4. Verification: The effectiveness of the anesthesia is verified by testing the numbness in the area.
5. Procedure Execution: Once numb, the healthcare provider performs the closed reduction, aligning the bones correctly.
6. Immobilization: A cast or splint is applied to maintain bone alignment and facilitate healing.

Duration

• The entire process, including anesthesia administration and the closed procedure, typically takes about 30 minutes to 1 hour.

Setting

• This procedure is usually performed in an outpatient clinic, hospital, or surgical center.

Personnel

• Anesthesiologist or nurse anesthetist (CRNA)
• Orthopedic surgeon or healthcare provider performing the reduction
• Nurses and medical assistants for support and monitoring

Risks and Complications

• Common Risks: Localized pain, swelling or bruising at the injection site, temporary numbness or weakness in the arm.
• Rare Risks: Allergic reactions to the anesthetic, nerve damage, infection at the injection site, incomplete anesthesia requiring additional medication.

Benefits

• Effective pain relief during the procedure.
• Minimally invasive with quicker recovery compared to open surgery.
• Immediate alignment of bones to promote proper healing.

Recovery

• Post-procedure monitoring for any adverse reactions to the anesthesia.
• Patients may experience some soreness or numbness which typically resolves in a few hours.
• Follow-up appointments to check the progress of bone healing.
• Instructions on care for the cast or splint and activity restrictions.

Alternatives

• General Anesthesia: For patients who may not tolerate regional or local anesthesia.
• Conservative Management: Using pain medication alone, though this may not effectively address bone misalignment.
• Open Reduction: Surgical intervention for more complex fractures, involving incisions to realign bones.

Patient Experience

• During the Procedure: The patient will primarily feel numbness in the affected area, with minimal to no pain.
• After the Procedure: Tingling or residual numbness may persist temporarily, and some soreness which can be managed with over-the-counter pain medications. Comfort measures include elevation and icing the affected limb as instructed.