How Is Regional Anesthesia Used During Surgery?

Regional anesthesia is a method of pain prevention for surgeries and procedures. In regional anesthesia, only the area of the body that would feel pain is numbed, allowing the patient to have the procedure while awake or while sedated but still conscious.

Spinal or epidural blocks are examples of regional anesthesia. They are injected near the spinal canal to block sensations in the lower body or limbs.

Regional anesthesia is different from general anesthesia, which works on the entire body, not just the surgery site, and the patient is conscious during surgery. It differs from local anesthesia in that a larger region of the body is numbed.

Why Regional Anesthesia Is Used

One benefit of a regional anesthetic is the patient can be consciously sedated or be fully conscious. A Cesarean section is an example of a procedure performed with the patient awake, with regional anesthesia (epidural) used to control the pain of the surgery. The patient can feel things above the abdomen, and she is able to carry on a conversation and see her newborn immediately after birth. By using regional anesthesia, the baby’s exposure to sedating drugs is lessened.

How Regional Anesthesia Is Given

Epidurals and other types of regional anesthesia are typically provided by an anesthesiologist or a nurse anesthetist (CRNA). Depending on the need, the anesthesia may be given with a needle, or a needle may be used to insert a flexible catheter line through which anesthetics and other medications can be administered throughout the procedure.

Regional anesthesia is provided by injecting specific sites with a numbing medication that works on the nerves of the body, causing numbness below the injection site. For someone having hand surgery, the anesthesia may numb their entire arm and hand, or the numbness may be mostly limited to their hand.

Epidurals and spinal blocks are both administered near the spinal cord. An epidural provides continuous pain relief as long as medications are continuously running and the patient does not have any side effects. A spinal block is given with a needle to the spinal sac, with the medication entering the cerebrospinal fluid. It uses a finer needle than an epidural.

The location of a peripheral nerve block depends on the specific region of the body that needs to be numbed. The anesthetic solution doesn’t enter the nerves but is injected near them. A nerve stimulator or portable ultrasound device might be used to locate the nerves that are the target.

Specific nerve blocks include:

• Paravertebral block: This injection is near the vertebrae (the bones of the spine). The location along the spine determines the region that is affected, such as the neck, chest, abdomen, hip, or leg.
• Brachial plexus block: An injection near the clavicle (collarbone) numbs the shoulder or arm, depending on the exact location of the injection.
• Femoral nerve block: An injection in the groin, near where the abdomen meets the thigh, numbs the front of the thigh and the knee.
• Sciatic and popliteal nerve block: An injection in the back of the leg numbs the back of the thigh, most of the lower leg, the ankle, and the foot.

Procedures 

• Gastrointestinal and liver surgeries, including colon resection and stomach surgery
• Gynecologic surgeries, including hysterectomy and Cesarean section
• Orthopedic procedures for bones and joints
• Thoracic surgery, especially for pain control after procedures on the chest or esophagus
• Urological surgery, including prostatectomy, nephrectomy, and bladder surgery
• Vascular surgery on arteries and veins