People with certain health problems choose local or regional anesthesia when that is an option, because it may pose fewer risks than general anesthesia in some situations. Long or difficult surgeries may require general anesthesia. A person choosing local or regional anesthesia needs to be able to lie still and remain calm during the surgery.
Medicine may be given to help with relaxation. Author: Healthwise Staff. Freedman MD - Anesthesiology. This information does not replace the advice of a doctor.
They choose to have sedation as well. You may remember everything, something or nothing after sedation. However, sedation does not guarantee that you will have no memory of the operation. Only a general anaesthetic can do that. For more information about sedation, please see our Sedation explained leaflet. Anaesthetic techniques can often be used together. For example, a regional anaesthetic may be given for pain relief after an operation for which you have had a general anaesthetic.
The general anaesthetic allows you to remain unconscious and remember nothing. At this time, your anesthesiologist may choose to inject a small amount of relaxing medicine into your intravenous line if you require sedation.
The anesthesiologist will feel your back, clean your skin with an antiseptic bacteria-killing solution, and place a sterile drape around the area. Your anesthesiologist may first inject some local anesthesia into the skin and then into the deeper tissues of the lower back - this may cause a slight burning or pressure sensation. Your anesthesiologist will then carefully insert the needle and advance it into the space between your vertebrae backbones.
Occasionally, you may feel a brief tingling sensation paresthesia during the procedure. For spinal anesthesia, the anesthesiologist advances the needle until he or she is able to inject some local anesthesia into the spinal fluid. Since a spinal block typically involves a one-time injection, the duration of your spinal anesthesia will depend on the type and amount of local anesthetic medication administered by your anesthesiologist.
For epidural anesthesia, the anesthesiologist advances the needle into the epidural space which is located just outside of the dural sac containing the spinal fluid. Your anesthesiologist may insert a small flexible catheter to allow for continuous injections or infusions of local anesthesia.
The needle is removed and only the catheter remains at the end of the procedure. Epidural analgesia is most commonly used to provide pain relief during childbirth or after painful surgical procedures of the chest, abdomen, and lower extremities.
After your anesthesiologist has performed the spinal or epidural block, you will generally feel numbness and may notice that your legs will become weak to the point where you may not be able to move them. This is normal. The surgery will be allowed to start only when your anesthesiologist is certain that the site of surgery is completely numb. During the surgery, you will have the option of being awake or sedated. If you choose to be sedated, the anesthesiologist will administer sedatives through your intravenous line to help you sleep lightly during the operation.
After surgery, you will be taken to the recovery room and monitored closely by recovery room nurse until your spinal or epidural block wears off. Typically, a spinal block lasts hours depending the type and amount of local anesthetic given by the anesthesiologist. If you received an epidural catheter, it can be left in place for several days after surgery to allow a continuous infusion of pain relieving medications.
Your epidural catheter is generally removed once you are able to keep down oral pain-relieving medications. The brachial plexus is the major nerve bundle going to the shoulder and arm. Depending on the level of surgery, your anesthesiologist will decide at what level he wants to block the brachial plexus. For example if you have surgery at the shoulder, your anesthesiologist may choose a nerve block interscalene or cervical paravertebral block performed at a location above the clavicle.
For surgeries below the shoulder joint or clavicle, an infraclavicular or axillary technique may be used. Your anesthesiologist may use ultrasound, a nerve stimulator or other techniques to help identify the appropriate location along the brachial plexus to inject the local anesthetic. If a nerve stimulator is used, you may feel the muscles in your shoulder or arm twitch. If you experience any sharp pain or any type of paresthesia "shock-like" sensation similar to if you were to hit your "funny-bone" in your elbow shortly before or during the injection you should notify your anesthesiologist immediately.
You should also notify your anesthesiologist before performing any brachial plexus block if you have any type of pain below the elbow, preexisting pain, or preexisting nerve injury. If you have serious respiratory lung, breathing problems you should notify your anesthesiologist before proceeding with the block. Your anesthesiologist will then decide whether a brachial plexus block is safe for you and will provide adequate analgesia for the surgery.
Paravertebral blocks can be utilized to numb a specific area in one part of the body depending on where the block is performed. For example, paravertebral blocks at the level of the neck can be used for thyroid gland or carotid artery surgery.
Paravertebral blocks at the level of the chest and abdomen can be used for many types of breast, thoracic, and abdominal surgery. Paravertebral blocks at the level of the hip can be used for surgeries involving the hip, knee, and the front of the thigh. In general, all paravertebral blocks are performed with a similar technique. Your anesthesiologist will feel your back, clean your skin with an antiseptic bacteria-killing solution, and may inject some local anesthesia into the skin and then into the deeper tissues of the back - this may cause a slight burning or pressure sensation.
It numbs a large part of the body, but you remain aware. Local anesthesia is for procedures such as getting stitches or having a mole removed. It numbs a small area, and you are alert and awake.
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