Capitol Anesthesiology Association - Services

The physicians at Capitol Anesthesia are actively involved in controlling pain after surgery. Several methods are used, but by far the most common method is with Epidural Anesthesia. This form of pain control is appropriate for operations involving the chest, abdomen, and legs. It thus comes into play for surgery such as lung surgery, major abdominal operations such as colon surgery, and major orthopedic surgery operations such as total joint replacement of the hip or knee. The epidural catheter is placed in the spine close to the nerves that carry sensation from the part of the body where the operation occurred. By infusing a mixture of a local anesthetic drug and a narcotic drug, pain can usually be well controlled for the first several days. Epidural catheters are typically used for the first several days after surgery, when pain would otherwise be at its worst, and then gradually weaned down and discontinued, normally followed by milder pain medications in the form of pills.

Epidurals normally provide good pain control without any appreciable sedation or alteration of consciousness, and most often the amount of local anesthetic drug required is not enough to affect the nerves that control the muscles. Patients are therefore able to walk at an early stage of the game, and can easily cough and deep breathe, helping to avoid the development of pneumonia.

Patients having other types of operation may be candidates for pain control using other forms of nerve blocks. In particular, major orthopedic surgery on the shoulder is amenable to pain control using what is known as an interscalene block, which is a type of Brachial Plexus Block. This type of block is performed in the operating room at the time of surgery, and involves an injection of long-acting local anesthetic drugs in the proximity of the nerves that supply the shoulder. The site of injection is on the side of the neck, near the base. The nerves are usually located using a nerve stimulator, a device that generates small impulses of electrical current. When the tip of the needle comes close to the nerves, the electrical current stimulates the nerves. This results in either a tingling sensation that travels down the arm, an involuntary twitching of the muscles of the arm or shoulder, or both. Once the nerves have been located, the anesthetic solution is injected, producing a block of painful sensations resulting from surgery that usually lasts for most of the first day. Many patients require additional pain medications to achieve good control, but the amounts needed are substantially reduced after interscalene block.