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Learning About Regional Anesthesia

What is regional anesthesia?

Regional anesthesia is the use of medicines to block pain from an area of the body, such as an arm or a leg or the belly. It's a safe way to relieve pain during a procedure. It can also help relieve pain after surgery. And it may reduce your need for other pain medicine after surgery.

This type of anesthesia can be used for many procedures. These include hand or foot surgeries and total joint replacements of the knee, hip or shoulder. It may also be used during childbirth.

What are the main types of regional anesthesia?

The main types of regional anesthesia are:

  • Peripheral nerve blocks. This is a shot near a specific nerve or group of nerves. It blocks pain in the part of the body supplied by the nerve. This is often used for procedures on the hands, arms, feet, legs, or face.
  • Epidural and spinal anesthesia. This is a shot near the spinal cord and the nerves around it. It blocks pain from the entire area of the body below where the anesthesia was given. This includes the belly, hips, and legs.
  • Intravenous regional anesthesia. This is also called a Bier block. It may be used instead of a peripheral nerve block for some procedures, such as for carpal tunnel surgery.

How is regional anesthesia done?

Regional anesthesia may be given with other medicines that make you relaxed or sleepy (sedatives) or that relieve pain (analgesics). It is sometimes combined with general anesthesia. These other medicines are usually given through a vein (IV).

Here's how the types of regional anesthesia are given:

  • Peripheral nerve block. Ultrasound, X-ray, or other imaging may be used to help guide the needle that will be used for the nerve block. After finding the right spot, the anesthesia specialist uses a tiny needle to numb the skin and the area beneath the skin. Then the nerve block needle is put into the numbed area.
  • Epidural and spinal anesthesia. You may need to sit up and lean forward. Or you will lie on your side with your knees curled up to your chest. You will get a shot of medicine to numb the skin on your back.
    • For a spinal, the specialist will give the medicine into the spinal fluid around your spinal cord.
    • For an epidural, the specialist will put a needle near your spinal cord. Then they will insert a catheter (a tiny tube) through the needle. The needle is then removed. But the catheter stays in your back to give the medicine.
    • Sometimes spinal and epidural anesthesia may be done together. This is a combined spinal epidural.
  • Intravenous regional anesthesia. A small tube (IV) is placed in the hand. A tight band is placed around the arm to reduce blood flow. Then the medicine is given through the IV.

People who get regional anesthesia are carefully watched. That's because the medicines used may affect blood pressure, breathing, heartbeat, and other vital functions. But problems rarely happen.

What are the risks of regional anesthesia?

In very rare cases, nerve damage can cause long-term numbness, weakness, or pain. This may happen if a nerve gets injured during the procedure.

Other problems can include infection, swelling, and bruising at the injection site.

The most common problem from spinal anesthesia is a headache. It's caused by leaking of the fluid that surrounds the spinal cord. This is very uncommon with elderly people. But it happens more often in young and middle-aged people. Spinal anesthesia can also cause rare and more serious problems, such as heart and breathing problems.

How can you prepare for regional anesthesia?

You will get a list of instructions to help you prepare. Your anesthesia specialist will let you know what to expect when you get to the hospital, during the surgery, and after.

You'll be told when to stop eating and drinking.

If you take medicine, you'll be told what you can and can't take before surgery.

You'll be asked to sign a consent form. The form says that you understand the risks of anesthesia. Before you sign, your specialist will talk with you. You'll discuss the best type for you. And you'll learn the risks and benefits of that type.

Many people are nervous before they have anesthesia and surgery. Ask your doctor about ways to relax before surgery. Relaxation exercises may be one option.

What can you expect after having regional anesthesia?

Right after the surgery, you will be in the recovery room. Nurses will make sure you are comfortable. As the medicine wears off, you may feel some pain from your surgery.

Tell someone if you have pain. Pain medicine works better if you take it before the pain gets bad.

You may feel some of the effects of anesthesia for a while. It takes time for the effects of the medicine to completely wear off.

  • If you had regional anesthesia, you may feel numb and have less feeling in part of your body. It may also take a few hours for you to be able to move and control your muscles as usual.
  • If you had medicine to help you relax (sedation) during surgery, wait 24 hours before you drive or operate heavy machinery, make important decisions, go to work or school, or sign legal documents.

Other common side effects of anesthesia include:

  • Nausea and vomiting. This usually doesn't last long. It can be treated with medicine.
  • A slight drop in body temperature. You may feel cold and shiver when you first wake up.
  • Muscle aches or weakness.
  • Feeling tired.
  • Trouble urinating. This may occur if you had spinal or epidural anesthesia.

For some surgeries, you may go home the same day. For other surgeries, you may stay in the hospital. Your anesthesia specialist will check on your recovery. They will answer any questions you may have.

Where can you learn more?

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