Regional Anesthesia, also known as a nerve block, is an anesthetic technique in which a part or area the patient's body is made numb (put to sleep) using a local anesthetic or numbing medicine. Orthopedic surgeries involve the extremities (e.g. Shoulder to hand or hip to foot) making them amenable to regional anesthesia. This type of surgery may also be associated with significant post-operative pain. Regional anesthesia can also be used to provide excellent long lasting post-operative pain relief in addition to providing intra-operative pain relief, making it very appealing for use with outpatient orthopedic surgical procedures. Many of our surgeons will discuss regional anesthesia with you during your pre-op visit.
If regional anesthesia is an option for your surgical procedure you will receive a pre-operative phone call from an anesthesiologist. He/she will review your medical history to determine if you are a candidate for a regional anesthetic technique/nerve block. The anesthesiologist will also explain how the nerve block is performed, the risks and benefits of the nerve block as well as what to expect from the block. This will also give you an opportunity to address any questions or concerns you may have about regional anesthesia.
There are several regional options available depending on the type of surgery, location of the surgery, duration of surgery, amount of expected post-operative pain and surgeon preference. (See Anesthetic Options For Your Surgery in the right column).
Simply put, regional anesthesia can be divided into two basic categories. First, peripheral nerve blocks in which local anesthesia or numbing medicine is place next to the nerves that supply the extremity. These blocks provide both good intra-operative pain relief and occasionally up to 24 hours of post-operative pain control. These blocks are used primarily for longer surgical procedures and ones in which a large amount of post-operative pain is expected. Second, the bier block/IV regional is a short acting regional anesthetic technique in which the local anesthetic is injected into a vein in the extremity. Again the bier block/IV regional provides good intra-operative pain relief. However unlike the peripheral nerve block it provides no post-operative pain relief. This technique is used for shorter procedures in which little post-operative pain is anticipated.
Combined with the regional anesthesia, the patient receives either sedation through the intravenous to provide different levels of relaxation and sedation or a light general anesthetic depending on patient and surgeon preference.
Patients can react differently to sedation and regional anesthetics. Therefore, from the moment the patient receives his/her block until the time the patient is comfortable in the recovery room, a member of the anesthesia care team will be caring for the patient the entire time. This is done to ensure the anesthetic is working perfectly and the patient is calm, comfortable and stable.
As with any anesthetic, there are inherent risks associated with regional anesthesia and fortunately serious complications are extremely rare. Prior to signing your consent the anesthesiologist will ask you if you understand the common and uncommon risks, side effects, and possible complications of the regional anesthesia technique listed on the anesthesia consent form. He or she will also answer any questions you may have.