If I am undergoing Hand or Wrist Surgery, should I have a regional anesthesia or a local with sedation?

After nearly 17 years of performing Hand and Wrist procedures--mostly in the outpatient setting, I have become a staunch advocate of Regional Anesthesia as opposed to using a local with sedation. That having been said, there are some providers who still perform even larger procedures such as fracture fixation and thumb basal joint arthroplasty using a local and sedation.

The reason I disagree with the use of local is that within 1-3 hours, there will be a sudden increase in pain, which will necessitate an increased use of narcotic pain medicine (hydrocodone, oxycodone, etc). These medicines have their share of side effects like nausea and constipation--so if my patient can enjoy 8-10 hours of pain relief from a "Block", it really makes the immediate postoperative period more tolerable.

At the surgery center that I work at, Linden oaks surgicenter,  the 2 Anesthesiologists that work with me are experts at Regional Anesthesia, thus I am comfortable that the pros far outweigh the small risk of a complication. I use Regional Anesthesia routinely for Shoulder procedures as well.

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