Advice after your nerve block for surgery
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Introduction
This information is about having awake breast surgery without a general anaesthetic to make you sleep during the operation.
Most people have a general anaesthetic for breast surgery. A general anaesthetic is often given together with a nerve block. This involves injecting a local anaesthetic medicine into your chest to:
- Make the nerves numb
- Ease the pain after the operation
In some cases, it is possible to perform the operation without a general anaesthetic at all. We can use chest wall nerve blocks to make the area being treated numb. Your surgery can be performed comfortably, while you are awake or lightly sedated.
You will:
- Stay awake
- Breathe normally
- Be able to talk with the team
- Not feel sharp pain during surgery
This information explains:
- The benefits and risks
- What happens on the day
- What to expect afterwards
Benefits of staying awake
There are many situations where it is safer for us to do breast surgery when you are awake. This is because we believe that a general anaesthetic would be a high risk to your health. Some examples include if you:
- Are afraid of general anaesthetic or want to avoid this for another reason
- Have severe heart or lung disease
- Are frail
- Previously had surgery or radiotherapy to your neck and it might be difficult to look after your airway during a general anaesthetic.
Other benefits include:
- Avoiding common side effects of general anaesthesia, like drowsiness, nausea and sore throat.
- Faster recovery, you can eat, drink and go home sooner. This is especially beneficial for diabetic patients.
- Excellent pain relief, the nerve block can continue to provide pain relief for several hours after surgery.
Your anaesthetist will discuss your medical history with you to determine if this approach is safer and a better option for you.
Risks of local anaesthetic injections
While we give you injections of local anaesthetic for your surgery, your safety is our priority. However, all medical procedures involve some risks.
This scale can help you to understand how likely you are to have a side effect or complication:
Very common
- Minor temporary effects: hoarse voice, droopy eyelid, mild shortness of breath. These usually resolve within a few hours.
- Injection site effects: bruising, mild bleeding, very rarely infection (1 in 100,000)
- Incomplete numbness: extra anaesthetic may be needed. Occasionally surgery may switch to general anaesthesia.
Uncommon
- Pneumothorax (air around the lung) may require monitoring or treatment.
- Temporary nerve irritation: tingling or numbness lasting weeks or months.
Rare
- Permanent nerve injury
- Haematoma: a small collection of blood near the injection site.
- Reaction to local anaesthetic medicine: if local anaesthetic enters the bloodstream it may cause dizziness and seizures. Your anaesthetic team is trained to recognise and treat this immediately.
What happens on the day
Before surgery your team will:
- Take you to a room where we plan to give you the local anaesthetic injection
- Check your details with you
- Attach monitoring equipment
- Place a small drip (cannula) in your arm
- Your anaesthetist will perform the local anaesthetic injection
You may feel:
- A small sting as the skin is numbed
- A pressure or cool sensation during the injection
- After about 20-30 minutes your breast and underarm will become numb.
Most people say the injection feels no worse than a regular needle.
During surgery:
- Your anaesthetist will do some checks to make sure your chest is numb for the surgery
- Your chest will be cleaned thoroughly with an anti-septic solution
- A screen will be placed so you don’t see the operation
- You may feel pressure or pulling but not sharp pain.
Anxiety about being awake for the operation
If you are anxious about being awake for the operation, we can:
- Give you a sedative medicine to make you feel more relaxed
- Play a selection of your favourite music during the operation
- Above all, a member of the anaesthetic team will stay with you throughout the procedure. They take good care of you and can deal with any concerns that you may have during the surgery.
Aftercare and going home
After your operation:
- You will stay in a recovery area or ward for a short period of observation
- Because you are already awake, you can usually drink fluids soon after surgery, eat light food and go home earlier.
As the numbness wears off:
- The nerve block can last up to 18 hours
- You may feel tingling or ‘pins and needles’ in the chest, this is normal.
Take your prescribed pain relief before the numbness completely wears off.
When to seek medical help
Call 999 or go to A&E if you have:
- Unexpected breathlessness
- Severe pain that doesn’t improve with medication
- Numbness lasting over 48 hours
For more information:
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Watch this video on nerve blocks.
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Contact us
If you have any queries relating to this information, please contact the Anaesthetics service.
About this information
Service:
Anaesthetics
Reference:
B/038
Approval date:
29 September 2026
Review date:
1 September 2029
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.