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Regional Anesthesia

Regional Anesthesia involves anesthetizing or numbing a region of the body such as the upper or lower extremities.  It may be used as the sole form of anesthesia allowing you to remain awake during the procedure, or in combination with a general anesthetic.  It can be useful with patients that prefer to be awake during their surgery and even potentially be able to watch a video screen showing parts of their surgery.  Regional anesthesia can not only allow you to be comfortable during the procedure but may even be able to provide pain relief after the surgery is over.  The duration of the pain control depends upon the local anesthetic used, where it is injected, and how you tend to respond to local anesthetics

Regional anesthetic techniques can be divided into central and peripheral techniques depending on where they are administered.

Central techniques include involve injecting medications near the spinal cord or spinal nerves and are useful for most surgeries on the lower extremities or lower abdomen:

  • Spinal, or sub-arachnoid anesthesia, is where medications are injected directly into the spinal fluid which bathes the spinal cord and spinal nerves.  This injection is done with a very small needle in the lower part of your back or lumbar region.  This technique typically blocks both the sensory and motor nerves at the level of the spinal cord.  Generally this is done as a “one shot” single injection but occasionally a small tube similar to an epidural catheter may be placed.  Medications are injected and then the needle is removed.  Spinals tend to have very rapid onset times and provide excellent anesthesia, but have a limited duration of action of usually about 2 – 4 hours.   Thanks to newer needle designs, spinal headaches are a thing of the past and rarely occur.
  • Epidural blocks are similar to Spinals, but medications are placed in the epidural space outside the dura (sometimes called the dura matter) or membrane that contains the spinal cord and spinal fluid.  It also blocks the sensory and motor functions at the level of the spinal cord.  The main advantage of an epidural is that a tiny tube or catheter can be placed in the epidural space and medications can either continuously or intermittently be added through this catheter without the need for additional needle pokes.  This means that an epidural can provide anesthesia for many hours or even days if needed.

Peripheral techniques involve the placement of medications near major nerve trunks.  These blocks typically block one arm or one leg.  Examples include:

  • Brachial Plexus Blocks such as Interscalene Blocks where an injection is made in the neck region blocking the nerves that go to the shoulder and arm.  This block is especially useful for surgery on the shoulder such as rotator cuff repairs.
  • Femoral Nerve Blocks are done in the groin area and help block pain in the lower extremities.  They are especially useful for ACL repair on the knee.  
  • Sciatic Blocks such as Popliteal Blocks can be very useful for blocking the pain associated with foot or ankle surgery.
  • IV (Intravenous) or Bier Blocks are used mainly on the upper extremity and are useful for hand or wrist surgeries.  This block involves the placement of a tourniquet similar to a blood pressure cuff on the upper arm.  Your arm with then be wrapped in a tight bandage and the tourniquet inflated.  A dilute local anesthetic is then injected into your veins below the level of the tourniquet.  This results in numbing your arm up to the level of the tourniquet and works well for surgeries, but is limited to about 1 hour or less in duration.

Disclaimer

IMPORTANT - This website is intended to provide an introduction to information as it relates to the practice of anesthesiology and is not intended to be construed as medical or anesthesia advice for your or any other particular situation. For additional information please Click Here.