Regional anesthesia is performed by using local anesthetics to block the nerve conduction or communication to part of the body so the patient cannot feel pain in that area. This is identical to when a patient is treated with a "shot" at the dentist's office to make the jaw sufficiently numb for dental procedures. We perform regional anesthesia similarly for some surgical procedures as well as to control post-operative surgical or labor pain.

 

There are 3 types of regional anesthesia:

 

1. Epidural Anesthesia

•  What:  Involves the placement of anesthetics within the epidural space of the spinal column. Depending on the location or "level" of the epidural injection, the anesthesia will block the conduction of nerves within this region of your body. Typically we place a catheter or "tube" in this location so we can continuously provide anesthetic using a medication pump.

• When: We commonly use epidural anesthesia for certain surgical procedures, post-operative pain management, and labor pain control.

•  How:  The technique is performed with the patient sitting or lying down in fetal position. An epidural introducer needle is used to find and place a catheter into the epidural space. It usually takes 15 minutes or more for the anesthetic to take full affect. Epidural anesthesia can be continued up to 5 days with the catheter in place.

• Risks and Side Effects: Common side effects include anesthetic failure of the epidural catheter (less than 1/100 cases) and a temporary headache known as a "spinal headache" (less than 1/200 cases). Temporary blood pressure drops are often common initially. Extremely rare complications include serious infection, paralysis, seizures, and heart collapse. Most studies do not support increased risk of back injury and pain from epidural anesthesia.

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2. Spinal Anesthesia

• What: Involves the placement of an anesthetic into the spinal sac located within the spinal column. A "spinal" is usually performed at the lower back level (lumbar vertebrae). Once the anesthetic is injected into the spinal sac, it affects the conduction of the spinal cord and nerves at that location. Typically patients cannot feel or move areas that are treated.

•  When:  We commonly use spinal anesthesia for certain surgical procedures and sometimes to provide post-operative pain management. It is also used along with epidural anesthesia for obstetrical surgery, such as Caesarian sections. 

• How: The procedure for placing a "spinal" is very similar to an epidural anesthetic. The "spinal" is placed using a very small needle. Once the needles reaches the spinal sac, anesthetic is administered and the needle is removed. The effect is much faster than epidural anesthesia and usually fully kicks in within 10 minutes. Spinal anesthesia can last up to 4 hours depending on the anesthetic used.

•  Risks and Side Effects:  The risks and side effects are similar to epidural anesthesia. The most common side effect is a temporary headache (less than 1/100 cases) known as a "spinal" headache. Temporary blood pressure drops are often common initially. Extremely rare complications include serious infection, paralysis, seizures, and heart collapse. Most studies do not support increased risk of back injury and pain from epidural anesthesia.

 

3. Peripheral Nerve Anesthesia

•  What:  Peripheral nerve anesthesia or "nerve blocks" are used to provide surgical and post-operative anesthesia. Specific areas of the body can be anesthetized by selectively injecting anesthetic to certain nerves. 

• When: Peripheral "nerve blocks" are most often performed to provide prolonged post-operative pain relief to specific areas of the body affected by surgery. Sometimes we will use these blocks for primary intra-operative anesthesia as well. These blocks can provide up to 24 hours of post-operative anesthesia and pain relief from surgery.

• How: Peripheral "nerve blocks" can be performed either before or after surgery depending on the clinical situation as determined by the patient, surgeon, and anesthesiologist. Typically a special nerve simulator is used to locate the specific nerve or nerve bundle. Once the nerve is located, anesthetic is injected causing a "block" in conduction from the targeted nerves. Depending on the anesthetic used, the full effect can take as long as 25 minutes to occur and can last as long as 24 hours.

•  Risks and Side Effects:  Each particular "nerve block" has its own specific risks and side effects. The most common risk is the failure of anesthesia ("failed block"). Prolonged nerve anesthesia or paralysis lasting up to 3 months is rare but does occur. Extremely rare complications include serious infection, seizures, and heart collapse.