Regional Anesthesia

Regional anesthesia is defined as the infiltration of a local anesthetic around one or more nerves to cause a temporary loss of sensation in a region of the body. Almost all procedures can also be used as continuous procedures for the time before (preoperative), during (intraoperative), and after (postoperative) surgery.¹

Benefits of Regional Anesthesia

The technique has been associated with favorable outcomes in patients undergoing a variety of surgical procedures. Beneficial effects have been demonstrated for postoperative respiratory and cardiovascular endpoints, 7-day survival, time to ambulation and hospital discharge, and postoperative analgesia compared with general anesthesia.²

Types of Regional Anesthesia

Regional anesthesia can be divided into:

• Neuraxial anesthesia
  • Spinal anesthesia
  • Epidural anesthesia
  • Combined spinal-epidural anesthesia
• Peripheral anesthesia
• Local and infiltration anesthesia

Neuraxial Anesthesia

Neuraxial anesthesia refers to the placement of local anesthetic in or around the central nervous system, which includes the brain and spinal cord.

Spinal Anesthesia

Spinal anesthesia, also called a spinal block, involves injecting a local anesthetic into the subarachnoid space. This results in sensorimotor blockade of the lower half of the body. It is therefore used for operations on the lower half of the body up to and including cesarean section.¹

Epidural Anesthesia

In epidural anesthesia, a local anesthetic is injected into the extradural space.³ It can be used for procedures from the interpleural space to the lower extremities.⁴
Combined Spinal-Epidural Anesthesia
Combined spinal-epidural anesthesia, as the name suggests, combines spinal and epidural anesthesia by first injecting local anesthetics into the subarachnoid space, followed by placement of an epidural catheter and subsequent epidural injection.⁴

Peripheral Anesthesia

The principle of peripheral regional anesthesia is to eliminate only those nerve cords that need to be directly anesthetized for procedural anesthesia.¹ The injection of local anesthetic around the nerve inhibits the action of voltage-dependent sodium channels, thereby inhibiting the neurotransmission of pain impulses and providing motor immobility.5 The nerves are localized by electrical stimulation, ultrasound, or a combination of both techniques. Peripheral anesthesia is particularly useful for procedures on the extremities.¹

Local and Infiltration Anesthesia

Local and infiltration anesthesia involves the administration of large amounts of local anesthetic into the surgical field. It has been used for several decades because of its simplicity, ease of administration, and effectiveness.⁴

Applications of Regional Anesthesia

Regional anesthesia can be used in a variety of surgical procedures, such as:

• Hip or knee surgery²
• Cesarean sections²
• Lower extremity surgeries²
• Upper extremity surgeries²

Regional Anesthesia Complications and Considerations

No technique is without risks, and regional anaesthesia is no exception. However, the safety – avoidance of complications – in regional anesthesia is dependent on the cooperative efforts of anesthesiologists, other care providers and persons with management responsibility.²

Concluding Thoughts on Regional Anesthesia

Regional anesthesia is an effective way to manage pain before, during and after surgery.² Whether it's neuraxial, peripheral, local or infiltration anesthesia, the benefits of this technique make it an essential tool in modern medical procedures.

Studies:

¹Kill C., Wulf H. (2009). Lokal- und Regionalanästhesieverfahren Prinzipien und Techniken. Chirurg, 80 (8): 745-749.
²Finucane B. T., Tsui B. C. H., et al. (2017). Complications of Regional Anesthesia- Principles of Safe Practice in Local and Regional Anesthesia. Springer International Publishing AG, 3.
³Jankovic D. (2008). Regionalblockaden & Infiltrationstherapie- Lehrbuch und Atlas. ABW Wissenschaftsverlag GmbH, 4.
4Hadzic A. (2017). Hadzic´s textbook of Regional Anesthesia and Acute Pain Management. McGraw-Hill Education, 2.
⁵Héroux J., Bessette P.-O., et al. (2023). Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review. BMC Anesthesiology, 23 (91).