Dupuytren's #5

Concerning recovery from regional blockade of the brachial plexus ...

Yesterday I wrote about regional anaesthesia involving an injection of local anaesthetic in the area of the brachial plexus. The anaesthetist told me that the effects would last for about 16 hours.
I described the surreal, dismembering experience of its onset and effects.
What follows is an account of the recovery.


My anaesthetist favoured the supraclavicular approach.

The operation lasted about 1 hour and 45 minutes, whereupon St. Anley is wheeled to a recovery area.
The staff here are different to those he met earlier, so, here we go again:
“Please tell me your full name.”
Etcetera, etcetera …

“Would you like a cup of tea?”
“Ooh, yes please; milk, no sugar.”
Tea duly arrives with two biscuits on the saucer.

St. A. is right-handed, so he has no difficulty in manoeuvring the cup to his lips to partake of the gloriously refreshing liquid.
Now, the biscuits: they are securely encased in a cellophane wrapping, but the nurse who brought them has gone elsewhere.
St. A. holds the packet in his right hand and vainly tries to bite through the cellophane.
Another nurse notices the struggle and asks, “Would you like some help?”
“Yes, please.”
Whilst unwrapping the digestives she enquires, “What’s your full name, DOB, address, telephone number … ?!”

I have absolutely no control over my left arm which has been suspended from a drip-stand by a pillow case.
“You may get dressed now,” says a third nurse.
Clearly, I should have come in with elastic-waisted trousers, and why, oh why, did I feel the need to wear a tie?

Nurse helps me by putting ‘bad’ arm into my shirt first.
I successfully manipulate my trousers onto my legs, but, with some embarrassment, I have to ask, “Please, can you do up my flies?”
All this takes some time, and St. A. begins to understand that the next few hours are going to present some significant challenges.
Eventually made decent and having discarded the tie, a triangular sling to support useless arm is constructed.

The first nurse returns.
We seem to be making progress as she doesn‘t need to ask my name!
Various bits of paperwork are completed and post-operative instructions passed on.
“Will Mrs. Saint Anley be collecting you?”
“Would you like us to give her a ring?
“What’s the telephone number?
“Oh, it’s alright, I’ve got it here!”

Mrs. St. A. duly arrives and transports me to our home, whereafter she diligently attends to my every need.
I still have no sensation in my left arm, so I have to be careful not to injure it by bumping into obstacles.
 
By the middle of the evening comes the very faintest notion that my motor facilities are returning.
First, my arm begins to move from the shoulder joint.
It does so with no cerebration on my part, and to no purpose.
It twitches, it gyrates vigorously, it abducts quite spontaneously.
I know it’s doing all these things because I can see it. However, my sense of its position in space has not returned, so, with my eyes closed, I don’t know where it is.

Then, I seem to be able to flex at the elbow, and the arm, totally unbidden, assumes a near-robotic waving motion.
"Have you seen someone you know?" enquires my wife!

By bedtime I still have no sensation, so I retire to a single bed since Mrs. St. A. wants to avoid being struck by a spontaneously moving plaster-clad arm in the middle of the night.
As instructed, I support the ‘bad’ arm on a pillow alongside me. ‘Bad’ arm, however, has other ideas and launches itself fitfully into the nearby wall.
No matter … I feel no pain.
The wall will polyfill and repaint!

I sleep surprisingly well until about 3.00am when I am awoken by that pleasant, warm, tingling sensation I described at the onset of anaesthesia.
“Ah, it’s wearing off,” I say to myself.

After that comes itching. I try scratching, but still with no real sensation, that makes no difference.

Eventually, all the chorea-form involuntary movements cease, and I can accurately identify the position of my arm in space.
I practise touching the tip of my nose with my index finger … YES!

By daybreak, I can feel light touch at my finger-tips.

What is demonstrated by this experience is that there are various modalities of sensation that recover at different rates, all somewhat later than motor function ...

• First comes tingling and temperature sensation.
• Nobody seems to know what the sensation of itch is all about, or why scratching alleviates it.
• Then comes joint-position sense.
• Light touch apparently takes a long time.

 
Pain comes last of all.

Now I know why I was prescribed those strong analgesics to take home from the hospital!