About Regional Anesthesia / Nerve Blocks
Regional anesthesia (also known as nerve blocks or peripheral nerve block) is used to block the sensation in a specific part of your body during and after surgery. It offers numerous advantages over conventional general anesthesia, including faster recovery time, fewer side effects, no need for an airway device during surgery, and a dramatic reduction in post-surgical pain.
Regional anesthesia is appropriate for a wide variety of procedures, from orthopedic surgery such as knee replacement to facial plastic surgery. At UC San Diego Health System, our Regional Anesthesia Division is recognized for its experience and expertise with this technique.
How it Works
In regional anesthesia, a numbing medication is injected around the nerves that transmit pain signals from the area involved in the surgery. The procedure “blocks” the nerves, ensuring that you will not feel pain during or immediately after surgery.
Depending on the specific numbing medicine (local anesthetic) used, the effects of the block can last even longer, ranging from hours to days. For some types of surgery, you may receive an infusion catheter, a very thin tube which can continuously bathe the nerve area in numbing medicine for an average of 2-3 days. Once the medication runs out, the catheter is removed, a simple procedure that you or your caretaker can perform.
Benefits of Regional Anesthesia
Because you will experience less pain, you won’t require as much post-surgery pain medication by mouth or intravenously, although we will make these prescriptions available to you. By taking less medication, you’ll reduce potential side effects such as drowsiness, upset stomach or dizziness.
Patients who receive regional anesthesia instead of general can also avoid post-procedure nausea, and recover very quickly after surgery. In many cases, patients may return home within hours of their procedure, rather than days. Hospital stays can also be significantly reduced. For a total knee replacement, for example, a patient can generally return home in two rather than four days.
Additional benefits of regional anesthesia include:
- Faster and easier rehabilitation due to reduced pain
- Ability to control your pain medicine using the self-dose pump on the infusion catheter
- Reduced dependence on care givers or family members due to faster recovery time
When it is Administered
Before your surgery, the regional anesthesiologist will locate the pertinent nerves using ultrasound or electrical stimulation to determine the optimal injection site. The numbing medication can then be injected with precision, without irritating or injecting the nerves themselves. This is generally done one half hour to one hour before your surgery.
- Getting this nerve block is no more painful than getting an IV. Your skin will be numbed before the procedure, and you may also receive mild sedation prior to the procedure.
Regional anesthesia can be used by itself or with conscious sedation, meaning you are drowsy but do not require an airway device to assist in breathing as you would during general anesthesia. If you prefer, we can also combine regional anesthesia with either intravenous sedation or general anesthesia, both of which allow you to “sleep” during surgery. You will have the opportunity to discuss your preferences with your anesthesiologist prior to surgery.
Where it is Administered
- Hand surgery
For minor hand and wrist surgeries such as carpal tunnel release, we use intravenous regional anesthesia (also known as a “Bier block”) which involves placing a second IV catheter in the hand undergoing surgery. We inject numbing medicine in the venous system which is trapped by a tourniquet and diffuses around the nerves. The numbness is very short-lived so we only use this technique for minor surgeries. For more extensive surgeries involving bones and/or joints, we perform nerve blocks at different locations depending on the site of surgery (finger, hand, or wrist) and the site of the surgeon’s tourniquet. Nerve blocks for hand and wrist surgery are most commonly performed in the axilla (axillary block) or at the shoulder (infraclavicular block).
- Elbow / forearm surgery
For surgeries involving the elbow, nerve blocks are most commonly performed in the axilla (axillary block) or at the shoulder (infraclavicular block).
- Upper arm / shoulder surgery
For surgeries involving the upper arm or shoulder, nerve blocks are most commonly performed in the area around your collarbone (interscalene block). For extensive arthroscopic shoulder surgery and shoulder replacement, we routinely place a catheter near the nerves to deliver numbing medicine into the area for 2-3 days. This facilitates your rehabilitation and reduces your need for other pain medications.
- Knee surgery
For surgeries involving the knee, nerve blocks are most commonly performed at the groin (femoral block). For ACL reconstruction and knee replacement, we routinely place a catheter near the nerves which can deliver numbing medicine into the area for 2-3 days. In addition to a femoral nerve catheter, we may perform an additional nerve block behind your thigh (sciatic block).
- Hip surgery
For hip surgery, nerve blocks may be performed in the back to numb the nerves responsible for sensation of the hip joint (“lumbar plexus block”) or an epidural may be placed. A lumbar plexus block is different than an epidural because a lumbar plexus block only numbs the nerves to one side.
- Foot / ankle surgery
For surgeries involving the foot or ankle, nerve blocks are most commonly performed in the area behind your knee (popliteal sciatic block) or at the level of the ankle (ankle block).
For more invasive surgeries of this area (for example, tendon/ligament repairs and fractures), we routinely place a catheter near the nerves which can deliver numbing medicine into the area for 2-3 days. This type of pain relief facilitates your rehabilitation and reduces your need for other pain medications.
- Facial surgery
For surgeries involving the face and neck, it may be possible to perform specific nerve blocks to minimize your postoperative pain. Common procedures that are suitable for nerve blockade include endoscopic sinus surgery, septoplasty, and rhinoplasty. Your anesthesiologist will discuss these options with you on the day of surgery and determine if you are a good candidate for nerve blockade.
To Learn More
At UC San Diego, the Regional Anesthesia Division specializes in performing nerve blocks for patients undergoing a variety of different types of surgery and for controlling post-operative pain. For more information about these procedures at UC San Diego Health System, and to find out whether you are a candidate, please call the Department of Anesthesiology, 619-543-5720.