Regional Anesthesia FAQ
Please tell me more about regional anesthesia?
Regional anesthesia involves the use of local anesthetic medication (“numbing medication”) to block painful sensations at different areas of the body in order to help with pain both during and after surgery. Types of regional anesthesia include peripheral nerve blocks and neuraxial anesthesia. There are several benefits to receiving regional anesthesia: improved pain control after surgery, a decreased physical stress response and associated behavioral response, decreased post anesthesia recovery time, and a reduction in the amount of narcotic pain medication necessary to treat pain after surgery.
A peripheral nerve block is a targeted injection of local anesthesia placed close to a nerve. Nerves are bundles of fibers that send signals, including pain signals, between the brain and other parts of the body. A nerve block is typically performed by anesthesiologists who use an ultrasound in order to achieve an adequate block and minimize risks.
Neuraxial anesthesia involves the placement of local anesthesia around and close to nerves involving the central nervous system. Although this type of anesthesia can be used as the primary anesthetic for surgery, for surgeries involving children it is typically used to help treat pain. Types of neuraxial anesthesia include spinal anesthesia, caudal anesthesia, and epidural anesthesia.
Depending on which area of the body is involved and the age of the patient, the block may be performed under sedation before surgery or after a patient is placed under general anesthesia. These techniques can involve a single injection of medication or may involve the placement of a small catheter to be used after surgery with an infusion of low dose local anesthesia to maintain good pain control for a longer period of time.
How is pain treated during and after the operation?
For more than a hundred years minor and major surgery was performed without analgesia (pain medication) on infants and small children; the theory was that the nervous system in infants was not fully matured and therefore infants could not feel pain. By the 1980s thankfully a growing body of scientific evidence showed what we now know without a doubt: infants and small children do indeed feel pain and can create large physical and behavioral stress responses to the pain of surgery. Further studies have shown that this stress response can cause sustained changes to the way that the brain processes pain signals and that these changes can last even after the wound has healed. These changes have been shown to influence behavioral response to painful events months later.
Ideally regional anesthesia is part of a “multi-modal” approach to pain control and is one tool that the anesthesiologist will use to help manage pain during and after the operation. The use of nerve stimulation and ultrasound guidance has expanded the potential for safe and effective use of peripheral nerve blocks in children. By using regional anesthesia to block the majority of pain signals to the brain, other types of pain medication can be used to lesser degrees. Your child’s anesthesiologist may utilize additional medications such as acetaminophen, anti-inflammatory medication like ibuprofen, and possibly narcotic pain medication. Narcotic pain medication may be necessary to help manage pain after surgery but can have side effects such as nausea, constipation, itchiness, delirium, reduced breathing and dependency with continued use. By reducing or eliminating the need for narcotic pain medication we are able to reduce and avoid these side effects.
Things to expect from my nerve block:
General side effects from any nerve block can include infection, bleeding, and damage to surrounding structures. In order to minimize the risk of infection the skin is thoroughly cleansed with a special cleaning solution prior to performing the nerve block. To minimize the risk of bleeding and damage to surrounding structures an ultrasound is utilized so that the nerve of interest can be targeted and blood vessels and other structures can be avoided.
Other possible side effects could include an unsuccessful block, bruising, intravascular injection of medication, local anesthetic toxicity. Each nerve block may have its own specific side effects as well depending on which area of the body is targeted. It is important to have a discussion with your anesthesiologist about block specific risks.