Regional Anesthesia

What is Regional Anesthesia?

“Regional anesthesia” (also known as spinal, epidural, or peripheral nerve block) involves having an injection of local anesthetics near a bundle of nerves to numb the area of your body that requires surgery. It “blocks” the sensation in a specific part of your body both during and immediately after surgery.

What are Peripheral Nerve Blocks?

“Peripheral nerve blocks” are specialized regional nerve blocks that can be performed as a single injection of numbing medications, or as a continuous infusion through a soft, thin tube. Your anesthesia care provider will discuss with you which type of block is best for you. For single injection nerve blocks in general, the numbness may last 6-12 hours. Much longer numbness, up to 24-36 hours is not uncommon for certain lower leg blocks. As the nerve block “wears off,” a feeling of “pins and needles” may be experienced. The surgery center staff will instruct you on what type of peripheral nerve block you have had and how to take your pain medications before the block wears off.

Interscalene Block:

An interscalene block can be used for anesthesia during surgery to the shoulder or upper arm. You will have your vital signs monitored and a small amount of sedation may be given prior to performing the block. Ultrasound imaging is used to facilitate the block. At the end of surgery, when your anesthesia wears off, you may notice that you are unable to move or feel your shoulder, arm, or maybe your hand. This is normal and may last several hours. The surgery center staff will instruct you on a medication schedule to help with pain control once the block wears off. Occasionally, an infusion of numbing medication may be connected to a catheter that is taped in place to help with pain control after your surgery. Some common concurrent effects of the interscalene block may include a droopy eye or lip on the side of the block (Horner's syndrome), your voice could become hoarse sounding, and it may feel different when you breath. All of these “side effects” will wear off when the numbness subsides.

Femoral Block:

A femoral nerve block may be placed for surgery at or above the knee, for instance, when having ACL surgery. The block is placed on the femoral nerve located around the crease where your thigh meets your abdomen. This block usually results in numbness to the thigh and knee area.

Sciatic Nerve Block:

Often a Femoral nerve block may be combined with a sciatic nerve block to get complete numbness of the leg. The sciatic nerve is located deep in the buttock and is difficult to discern with ultrasound guidance. The preferred approach at our center is to use a nerve stimulator to locate the nerve. A small electrical pulse is delivered through the needle which causes movement of the foot and toes when the needle is near the nerve.

Popliteal Block:

A popliteal nerve block is another form of sciatic nerve block which is placed further down the leg. It can be used for anesthesia during surgery to the ankle and foot. You will have your vital signs monitored and a small amount of sedation may be given prior to performing the block. Ultrasound imaging is used to facilitate the block. This block is usually done while you are lying on your stomach. At the end of surgery, you may notice that you are unable to move or feel your lower leg or foot. This is normal and may last several hours. The surgery center staff will instruct you on a medication schedule to help with pain control once the block wears off. An infusion of numbing medication may be connected to a catheter that is taped in place to help with pain control after your surgery.

Peripheral Nerve Techniques:

Anesthetists at Pend Oreille Surgery Center use ultrasound to visualize targeted nerves for peripheral nerve blocks. Ultrasound imaging utilizes reflected sound waves to locate nerves in various locations, it also helps identify blood vessel and bone. The probe receives the reflected waves and an image is created on the ultrasound screen. This helps to guide placement of the block around the nerve. Your anesthetist will administer medication to relax you prior to numbing the area. At times the blocks are performed using nerve stimulator as well. If used, you may feel a small electric sensation that will cause movement in your arm or leg. Most people tolerate this very well with minimal discomfort.

Home Care for Nerve Catheters:

Your anesthetist and the surgery center staff will instruct you on how to care for a peripheral nerve catheter at home if it is decided that this therapy is beneficial for your recovery. A family member should also be available to help with your care at home.

Deciding which type of anesthetic technique is best for you

Once you are admitted to the pre-op area, a member of the anesthesiology team will discuss your options for anesthetic techniques. Your medical history will be reviewed, along with the benefits and risks of the techniques offered. It is important to review with the anesthetist any medical conditions and any medications and herbal remedies that you are currently taking. If you are sensitive to certain medications, especially those prescribed for pain, it is important to notify the medical team so that your postoperative recovery can be planned with alternative medications.

AAAHC