Anesthesia for surgery on ganglion cysts

Can the removal of a ganglion cyst be performed under local anesthesia?

When selecting local anesthesia the surgeon injects the anesthetic agent directly into the surgery area above the ganglion cyst. This type of anesthesia is simple and not too strenuous on the patient.

However, this approach also has serious downsides: The injection into the surgery area will impair the visibility later on during the procedure.   

Surgery on a large ganglion cyst, or – as shown in the image – surgery on a ganglion cyst close to the radial artery in my opinion cannot be performed in a secure fashion unless the operating surface is bloodless.

Take a close look at the image:

You do not see the slightest sign of blood. This can only be achieved by applying a cuff to the upper arm to block the blood flow in the arm during surgery (see below bloodlessness).

The bloodless operating surface is of great advantage to the surgeon. The very sensible structures in a hand or in a wrist can only be visualized and protected appropriately if the operating surface is bloodless.

Which type of anesthesia is applied for surgery on a ganglion cyst of the wrist?

There basically are different types of anesthesia that may be applied:

  • General anesthesia (deactivation of consciousness)
  • Brachial plexus block (anesthesia of the entire arm)

 

Wouldn´t it be better to perform surgery on a ganglion cyst of the wrist under general anesthesia?

It is certainly possible to select the general anesthesia for this type of intervention. Many departments in fact practice this approach.

Personally I prefer the brachial plexus block (anesthesia of the entire arm) for this type of surgery. The brachial plexus block has the advantage to provide reliable pain relief for several hours after the procedure.

Particularly in an area like the wrist which is rich of pain-sensitive nerves, an extended period of painlessness after surgery is a great plus for selecting the brachial plexus block.

In addition, the patient will be able to enjoy a meal shortly after the procedure.

What does the term “brachial plexus block” mean?

This form of regional anesthesia requires the injection of an anesthetic agent close to the nerves of the plexus in the shoulder area.

The brachial plexus is a network of larger nerve trunks, which run from the lower neck underneath the clavicle into the armpit.

The anesthesia is administered in close proximity to these large nerve tracts!

 

In case of brachial plexus block a local anesthetic agent is injected into the shoulder/armpit area to numb all branches of the brachial plexus. In most cases the entire arm and hand are numb and cannot be actively moved within around thirty minutes of the injection.

The most commonly used injection site in connection with a brachial plexus block is the armpit. In medical jargon this form of anesthesia is also referred to as axillary block.

The physician injects an anesthetic agent into the armpit.

What is the advantage of brachial plexus block for procedures on hands and forearms?

Surgery to remove a ganglion cyst of the wrist located close to the radial artery must be performed on a bloodless operating surface.

This considerably lowers the risk to injure a blood vessel.

Only a bloodless operating surface will allow the surgeon the required visibility needed to accurately operate on a wrist or in proximity of an artery (radial artery)!

This considerably lowers the risk to injure a blood vessel.

Only a bloodless operating surface will allow the surgeon the required visibility needed to accurately operate on a wrist or in proximity of an artery (radial artery)!

In order to avoid bleeding during surgery on a ganglion cyst of the wrist, a cuff is applied to the upper arm. (Image above: The cuff applied here works similar to a blood pressure cuff).

Just as the blood pressure cuff, the cuff used during surgery on a ganglion cyst of the wrist is pumped up with air, creating an unpleasant pressure sensation on the upper arm. This pressure is maintained during the entire procedure! While experiencing brachial plexus block anesthesia, however, the patient does not consciously feel discomfort.

This anesthetic method is much less strenuous on patients than general anesthesia. Patients mostly appreciate that they are allowed food and drink shortly after the procedure. From a physician’s point of view this approach stands out because of the duration of numbness that keeps the patient painless for an extensive period of time without needing additional pain-killers.

If desired a light sedative can be injected along with the anesthesia in order to allow the patient to sleep through the process – without ever being completely out!

All anesthetic methods which aim at numbing the entire arm will be experienced by the patient without almost any discomfort coming from pressure in connection with the cuff.

Therefore most surgeons prefer the brachial plexus block when operating on a ganglion cyst of the wrist (particularly when operating in proximity of the radial artery).

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