Meet the patients: Ian

Ian Ford had one of his knuckles replaced - while he was still awake.

The dad-of-two is one of a growing number of patients to undergo surgery without the need for a general anaesthetic.

He has been described as one of the most complex patients seen by doctors at Southampton General Hospital. They knew the arthritis in his hands could be improved with a knuckle replacement, but his other illnesses made a general anaesthetic highly risky.

Luckily for Ian, doctors at UHS now regularly carry out ‘awake surgery’ for a range of upper limb operations.

Ian lists at least ten illnesses that he suffers from, including Parkinson’s, diabetes, osteoporosis, arthritis and coeliac disease. He also has no antibodies, and is therefore very susceptible to infection.

The problems began when he had his spleen removed, when he was 23 years old and living in Sheffield. Now 59, Ian lives in Fareham, and has been a patient at Southampton General Hospital for 28 years. Consultant anaesthetist Harry Akerman and consultant hand surgeon David Warwick are working together to develop the awake surgery service in Southampton.

Mr Warwick said: “Avoiding a general anaesthetic not only improves the patient’s experience, it also allows us to operate on more patients each day, therefore reducing waiting times.”

Dr Akerman explained: “Mr Ford suffers from the lung disease bronchiectasis, leading him to get short of breath very easily and also making him susceptible to chest infections. By using a brachial plexus block instead of a general anaesthetic, surgeons can carry out certain operations while patients are still awake and able to breathe for themselves.”

Nerves are identified using an ultrasound machine and local anaesthetic can then be placed next to the nerves, leading to a numb hand and arm.

Thanks to these developments, some higher risk patients are now being offered surgery, and their recovery is usually quicker, without the need for an overnight stay in hospital.

Ian said: “I watched the ultrasound machine while they put the anaesthetic in my arm and although they put a screen up I did have a peep to try and see Mr Melikyan, my surgeon, replacing my knuckle!

“I would definitely recommend it, as you can go home much quicker.”

Consultant hand surgeon Erman Melikyan said: “I saw Ian about a year ago and he was complaining of intrusive pain in his knuckle. He was looking for a definitive solution and a joint replacement was the ideal treatment for his worn out knuckle. I am very pleased that we were able to do this surgery and all has gone well so far. I am also delighted that Ian had a very positive experience whilst under our care.”

This story was first published in Connect magazine.