Capitol Anesthesiology Association - Services

Epidural Anesthesia

Spinal Anesthesia

Brachial Plexus Block

Ankle Block

Bier Block

Regional anesthesia is a little easier to talk about because the concept is a little simpler. Basically, regional anesthesia involves the application of local anesthetic medicines to large nerves that supply a major part of the body with sensory (sensation) and motor (muscle control) nerve fibers. It's worth focusing on the difference between local anesthesia and local anesthetic medicines at this point. Local anesthetic medicines include drugs that chemically interrupt the transmission of impulses along a nerve fiber. Thus the sensation of what's happening to the body never reaches the brain, and messages from the brain never reach the muscles.

Regional anesthesia is a broad category that includes such techniques as epidural anesthesia, spinal anesthesia, brachial plexus block, ankle block, and bier block. There are many other examples, but these will serve our discussion. What all these have in common is the injection of a precisely located dose of local anesthetic medicine in the vicinity of large nerves. As described earlier, this interrupts the transmission of nerve impulses, temporarily "clipping the wires," so that the part of the body supplied by that nerve "goes to sleep". Surgery can then proceed without pain to the patient, and muscle relaxation is achieved for that part of the body due to block of the motor nerves (nerves that supply muscles).

Epidural and spinal anesthesia are administered by injecting the medications into the spine where they affect the nerves as they leave the spinal cord. Both, but especially epidural anesthesia, are extensively used to provide anesthesia for labor and childbirth. Brachial plexus block can be achieved in many ways, but all involve the injection of local anesthetic medications to the nerves that supply the shoulder and arm. Bier block is a special case of regional anesthesia that is widely used; it involves the intravenous use of local anesthetics, usually in the arm, that are kept in place by a tourniquet for the duration of the surgery. In certain cases, but not all, epidural anesthesia can be continued after surgery to provide epidural post-op pain management.

Are patients awake with regional anesthesia? They can be. With adequate pain control from the anesthesia, sedation is not absolutely required, and some patients actually request that no sedation be administered. However, most patients are somewhat anxious about having surgery and request that sedation be given during their regional anesthetic. In our practice this is the norm. Usually the patients receiving sedation become relaxed and comfortable in the operating room and have no memory of their surgery, but are not as deeply sedated as they might have been under general anesthesia.