News | Feature

"Awake surgery" is on the increase and with good reason

22 Nov 2019

Professor Tony Kochhar, Consultant Shoulder and Upper Limb Surgeon, explains how he uses interscalene -  a highly selective nerve block - to perform 'awake surgery', an effective alternative to general anaesthetic, which can provide extra long-term security for patients. 

During surgery 1 in 14 patients over the age of 65 suffer from covert strokes which, typically go undiagnosed as they do not present clinical stroke symptoms.

However, 42% of these cases risk cognitive decline within a year of their operation, according to a recent study published in The Lancet medical journal.

This isn’t the only risk factor, other complications may occur during surgery under general anaesthetic and recovery can be more painful and take longer. 

So what is the alternative?

Professor Tony Kochhar, Consultant Shoulder and Upper Limb Surgeon, is providing patients with options, based upon their individual needs.

This is particularly beneficial for those over the age of 65, at cardiac risk, people who have other health factors to consider, or for those who simply prefer to be ‘awake’ during their surgery.

What is this surgical technique used for?

Interscalene is a highly selective nerve block which can be used for all types of upper limb surgery - both minimally invasive keyhole surgery and open surgery. 

A nerve block being applied to a patient (stock image)

What are the advantages of using this surgical technique over more traditional methods?

Regional anaesthesia can significantly reduce post-operative pain, thereby reducing the need for painkillers resulting in fewer complications and a shorter hospital stay. 

If you are able to do so, remaining 'awake' during surgery significantly reduces the risk of a covert stroke occurring, particularly in older or more vulnerable patients.

Who is suitable for this type of surgery?

  • Anyone who is concerned about feeling out of control because of being put to sleep
  • Those who are older, or who’ve had medical problems, heart trouble in particular and the risk of an anaesthetic worries them
  • Those who have previously had an operation under general anaesthetic and just felt awful afterwards – nauseous, lethargic, not sleeping properly, in lots of pain

In all these cases it wasn’t the operation, but the general anaesthetic which made them seek alternative options, more suitable for them as individuals.   

Are there side effects?

As with any medical procedure some side-effects can occur, but these are typically mild and rare.  They can include:

  • drooping of the eyelid
  • flushing of the face
  • hoarseness of voice
  • shortness of breath (dyspnea)

If they occur they will only last for the duration of the block and then wear off as the nerves are no longer anesthetised.  

Are specialist drugs used to help the patient stay awake?

No, the block in itself doesn’t make patients sleepy so they don’t need any additional drugs to stay awake.

However, they can opt to be sedated if they would rather not see the surgery taking place and this can be done using a mild sedative. 

How is the anaesthetic administered and does the patient feel pain?

We perform the injection of the local anaesthetic using an ultrasound machine which not only allows us to identify it has been correctly placed, but also to see the appropriate spread of local anaesthetic around the nerves. 

The anaesthetist constantly monitors the patient’s responses throughout the operation and will adjust the levels if there is any change in their responses. The patient shouldn’t feel any pain whatsoever during this surgical technique.

A view from a patient

Michael Linnit, acclaimed theatre and musical producer and a patient of Professor Kochhar shares his experience:

Why did you choose to have your surgery under local anaesthetic?

I didn't know when I first saw Professor Kochhar that it was possible to have this surgery under local anaesthetic. 

When he discussed it and explained that it was possible, that he had developed and refined this technique, and that he would in fact recommend this for me, I chose to have it this way.

How was your experience of having the anaesthetic and operation?

I remember it being a pleasant experience.  I was sedated and felt a bit woozy afterwards but I didn't feel the panic of not being able to move my limbs, as the anaesthetic was so localised and didn’t affect my movement.  

As the anaesthetic wore off the painkillers took over and there was a fuzing of the line between anaesthetic and painkillers which, made the experience more comfortable for me.  

I wouldn’t hesitate to recommend Professor Kochhar's practice.

Further information

To book an appointment with Professor Tony Kochhar please call: 020 7234 2771 or email:

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Any views expressed in this article are those of the featured specialist(s) and should not be considered to be the views or official policy of The London Clinic.