CH8 - Center for Hand Surgery and Therapy - Geneva - Switzerland

About surgery

PWhatever the type and amount of surgery required, it will be performed according to the actual rules regarding every aspect of quality control and safety, in our own operating room at the Center or in the city clinics.

Before Surgery

Preoperative checks

Most operations are performed under local or regional anesthesia and under tourniquet control, that is without any bleeding.
An health check-up with blood control, ECG, etc.. is not necessarily required by the surgeon. However,  any acute or chronic general disease must be announced  (e.g.: diabetes, allergies, hemophilia, epilepsy, hepatitis, VIH, etc..) or any passed disease which may have been followed with sequellae (e.g. : heart diseases,  gastritis,  etc). 
Any actual medication must be announced: anticoagulation or antihypertensive drugs, aspirine,  neuroleptics,  etc.  Ask your physician or surgeon if you have any question.

Skin preparation  and asepsy

Have a shower before surgery.
Remove rings from your fingers and cut your nails short (except for women).
Check in at the Center or Clinic at the scheduled time.
You will have to be dressed in a surgical coat before surgery.
The skin of the region to be operated will be cleaned and shaved if necessary.
Once installed on the operating table, the hand and forearm will be thoroughly disinfected with a sterile solution and then draped with sterile dressings.

Anesthesia

For surgery of the hand and of the upper extremity, four types of anesthesia are used :

Local anesthesia

(You better have a light meal before surgery).
The local anesthetics is given under the skin. This hurts only little. A few minutes are allowed for the anesthesia to be effective. The tourniquet is then inflated and the surgery can be started.  It usually takes no more than 10’ to perform the essential of the procedure (e.g. carpal tunnel or trigger finger). The tourniquet is then released and the bleeding controlled by electrocautery.
Risks : vagal shock (fainting),  bradycardia and  low blood pressure.  Oxygen and simple means are  used and quite effective in most cases for rapid return to normal condition.

Endovenous regional anesthesia

(light meal no later than 2H before surgery).
After application of a tourniquet, a specific amount - depending on the patient body weight – of local anesthetic is injected into a vein of the hand or forearm. About 10 minutes are required to obtain the anesthesia, which is very effective and may last for 30 to 45 minutes. The tourniquet is then released and the vital signs are carefully observed in order to immediately manage and treat any general reaction to the anesthetic once released into the blood flow.
Risks : they are minimal and may only occur in case of premature opening or bad application of the tourniquet, or overdosage of the anesthetics (that’s why we have to know your actual body weight). Collapse, cardiac arrest and convulsions are the possible complications. We never observed them yet. The venous catheter settled on the other arm is intended to infuse the antidote if required.

Axillary block

(better have an empty stomach, no meal 6H before surgery).
This technique is suitable for all operations in the hand, forearm and elbow. The slight pain during injection in the axilla is well tolerated, even in children. After injection of the local anesthetic, about 30 minutes are required for full effect. This effect last for 4 to 12 hours depending on the type of anesthetic used. During this time, the hand and arm are completely anesthesized and cannot be controlled voluntarily because of the sensory and motor paralysis which occurs.
Risks : this method carries very little risk providing the correct technique is used. Puncture of the underlying vessels may result in bleeding and hematoma, which usually resolve within few days. Nerve irritation (neuritis) has been described and may last for a few days to a few weeks.

General anesthesia

This type of anesthesia is performed by anesthesiologists only. A preoperative health check-up is usually mandatory. Nowadays, general anesthesia is particularly safe and well tolerated (easy awakening). Postoperative pain is less well controlled than with axillary blocks, that last longer.

Surgery

Surgery is performed by the surgeon you choosed and who examined you at the preoperative visit.
Ask for premedication if you feel anxious about the operation. However, confidence in your surgeon and the staff is the better prevention and will help you to relax. Do not hesitate to talk and ask about what is happening or will happen, if you feel like it. It is our job to explain things and make you feel at ease.
When operated under local or regional anesthesia, you may ask any question you may have during surgery.
You will not be able to watch your operation, except at the Clinique de la Plaine, where a video installation allows it.
Vital signs (pulse rate, blood pressure and blood oxygen) are continuously monitored during the operation time. Safety is guaranteed by a spezialized nurse or the anesthesiologist who get ready to intervene if necessary.

After Surgery

The dressing and possibly the cast made by the surgeon at the end of the operation is intended to be perfectly adjusted and must be comfortable. Its role is to immobilize the operated part and to leave other parts free to move. It also drain blood from the surgical wound. It must not be compressive. In case your fingers turn blue or white, or get less sensitive, give a call to your surgeon or the center.
The dressing will be changed and the wound inspected within a few days from the operation, depending on the type of surgery.
Rest after surgery : even after a local anesthesia, you will be asked to lay and rest for a while, in order to be sure that vital signs are fine once you’ll leave. (about 15’ after local anesthesia, 30-45’ after endovenous anesthesia 1-2 hrs after an axillary block).
Pain following surgery usually last 1 to 3 days, rarely longer. You will receive the appropriate pain killers from your surgeon.
The most effective way to alleviate pain and prevent the swelling which occurs normally after an operation (especially in the hand) is to hold your hand at the shoulder level as often as you can. It is also recommended to move regularly your fingers, elbow and shoulder (10 full motion each every hour during daytime).

What to do in case of a problem?

The hand normally hurts somewhat during the night following the operation. The pain killers and simple means given above will help you to stand the pain. In case of persistent or increasing pain, contact your surgeon or the Center.
In case of fainting or increasing discomfort, call your surgeon or your physician. If you cannot reach them for any reason, call SOS Médecins, the hospital or the Clinique de la Plaine.

CH8 | Charles-Humbert 8 | CH-1205 Geneva
Tel: +41 (0)22 595 08 08 | Fax: +41 (0)22 595 08 02 |
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