Many types of anesthesia can be used for orthopedic procedures. The type of anesthesia chosen depends on the nature and duration of the surgery, the patient’s health and medical conditions, and the preferences of the patient, surgeon and anesthesiologist.

Very large or long operations usually require general anesthesia. This is frequently combined with regional anesthesia. Small, short procedures on the hand or foot can be done with local anesthesia alone or with a combination of local anesthesia provided by the surgeon and some sedation provided by the anesthesiologist (also known as MAC). Occasionally, neuraxial (epidural or spinal) anesthesia is chosen for hip or lower extremity surgery

Regional Anesthesia

Regional anesthesia is sometimes referred to as a “nerve block.”  Part of the body is put to sleep by injecting numbing medicine through a needle placed along the path of nerves.  The numbing medicine blocks the transmission of pain signals to the brain. For upper extremity surgery the injection may made be around the collarbone or neck, under the arm, or through an intravenous (IV) line in the hand.  For lower extremity surgery, the injection may be made in the groin or the back of the leg. Usually, an ultrasound machine or nerve stimulator is used to assist in finding the proper placement for the needle.

Can Regional Anesthesia Be Used Alone?
Yes. However, it is usually combined with general or MAC anesthesia.

Why Choose Regional Anesthesia?
The major advantage of regional anesthesia is better postoperative pain control. Therefore, there is less post-op narcotic use. This allows for faster recovery from anesthesia and less narcotic use.

Video

Here is a link to a video of a sample regional anesthetic nerve block. The block shown is called a supraclavicular block. While the anatomy may be different for other specific blocks, the general procedure is very similar.
http://www.youtube.com/watch?v=YOOoNT27Irg

Is Placing the Block Painful?
The injection of numbing medicine with a needle before surgery can be slightly uncomfortable but you will have medication to help you relax and feel comfortable during block placement.  Occasionally, a small amount of local anesthetic is injected around the site where the block needle is to be placed. The anesthesiologist may use a needle connected to a nerve stimulator to precisely locate the nerve. This causes muscles to twitch and move, which is not painful, although it can feel strange.

How Long Will the Numbing Block Last?
Placing the block usually takes around 5 to 15 minutes.  The numbing medications used in regional anesthesia can provide from 1 to 24 hours of pain relief, depending on the specific medication used.  The muscles controlled by the nerves that are blocked may also be weak until the block wears off.  You will be given back-up medicine by mouth or by IV, in addition to the numbing medicine in the block.

Are there any Complications?
As with any anesthetic, there are risks associated with the benefits of regional anesthesia. These include incomplete pain relief, soreness or bruising at the needle site, or tingling that lasts for several days. Serious complications can occur but these are very rare. Rare complications significant bleeding, infection, or nerve injury. Your orthopedic surgeon and anesthesia provider will check to make sure you are comfortable before, during, and after the procedure. Do not hesitate to tell them if you are not.

Types of Regional Anesthesia

  • Upper extremity nerve blocks typically aim to block the, “brachial plexus,” the network of nerves that supply the arm, forearm and hand.
  • Lower extremity blocks typically aim to block either the sciatic nerve or femoral nerve or both nerves.

Specific Blocks

  • Supraclavicular Block: The numbing medicine is injected above the collarbone, shallow to the lung and outside of the great vessels. This block is more widely used than in the past because newer technologies have made it safer. It provides anesthesia to the upper arm, the elbow, the wrist and the hand.
  • Axillary Block: The numbing medicine is injected under the armpit (the axilla). This generally provides good anesthesia for hand, wrist, forearm and elbow surgery.
  • Interscalene Block: The numbing medication is injected towards the brachial plexus below the collarbone (clavicle). This type of regional anesthesia provides good anesthesia for wrist, forearm, upper arm and often shoulder surgery.
  • Infraclavicular Block: The numbing medication is injected towards the brachial plexus below the collarbone (clavicle). This generally provides good anesthesia for wrist, forearm and elbow surgery.
  • Bier Block: The numbing medicine is injected through an IV line in the arm being operated on, with a tourniquet around the upper part of your arm to hold the medicine in the arm, preventing it from leaking out to the rest of your body. This type of block is useful for short procedures such as carpal tunnel surgery.
  • Rescue Block: The numbing medicine is injected after surgery to make you more comfortable, or after one of the blocks above has been performed, in order to complete your anesthesia.

What type of anesthesia should I have?
The type of anesthesia used for orthopedic surgery depends on the nature and duration of the surgery, your general health and any medical conditions, and your preferences as well as those of your doctors. You and your doctors can decide together what method is best for you.