INSTRUCTIONS FOR PATIENTS:

LOCOREGIONAL ANESTHESIA (LRA)

General Information.

What is anesthesia and do I need it?

What is anesthesia?

All surgical procedures cause pain. Today, there are medications (called anesthetics) that can be given so that you will not have pain during surgery. Anesthesia consists of the administration of these medications to prevent you from having pain during (and after) surgery.

Do I need anesthesia? 

YES. All surgical procedures cause pain and therefore require anesthesia. Without adequate pain control, it is not possible to perform the surgery. 

What are the different types of anesthesia?

There are three types of anesthesia: 

General Anesthesia
Often referred to by the patients as “going to sleep”. General anesthesia is a medical intervention performed by your anesthesiologist who uses a combination of medications that induce sleep, and analgesia (diminution of pain). Medications are given through a vein in your hand or arm so that you will “sleep” through the surgery. You will feel no pain during the surgery.

Regional Anesthesia
As the name implies, regional anesthesia sleeps (blocks the pain) in a specific area of your body. Medications are given in areas of the body where you will have surgery. Although you will be awake, these areas will be numb so you will feel no pain during surgery. The normal sensation and the ability to move your arm(s) or leg(s) will return when the effect of the medication wears off.

Local Anesthesia
Medications are given to a very small part of the body where you will have surgery, such as a tooth. Although you will be awake, this small area will be numb so you will feel no pain during surgery. Local anesthesia can be applied by injection (tooth), drops (eyes), spray (throat), cream, or gel (skin).

What are the different types of regional anesthesia?

There are several types of regional anesthesia:

Spinal Anesthesia
A procedure where the numbing medication (called local anesthetic) is given with a small needle through your back. As a result,  you will not feel your body below your waist.

Epidural Anesthesia
Similar to spinal anesthesia. With epidural anesthesia, the numbing medication (local anesthetic) is given through a very small plastic tube that is placed in your back (this plastic tube is called a catheter). The catheter allows your anesthesiologist to administer new doses of the medication when necessary. Epidural analgesia is very often used for pain during labor.

Nerve Block
The numbing medication (local anesthetic) is given in areas of the body that require surgery (e.g., arm, leg, or foot) so you will feel no pain during surgery. A nerve block is usually given before surgery and can last for many hours after surgery. The normal sensations will return when the effect of the medication wears off.

Regional and General Anesthesia Combination
Regional anesthesia can also be combined with general anesthesia.  With the combination, you still “go to sleep” during your operation but the regional anesthesia given by your anesthetist decreases the amount of general anesthesia needed, and decreases, or eliminates the pain after the operation.

Which anesthesia is best for me?

Selecting the best anesthesia type for each patient and surgical procedure is important. You should always trust your anesthetist’s choice of this. The anesthetist will decide on the type and amount of anesthesia you need based on several factors, including:

  • The site of the surgical intervention
  • The duration of the surgical procedure
  • Your medical history 
  • Allergies
  • Previous reactions to anesthesia (yours or your family’s)
  • Medications you are taking
  • Your age, height, and weight

The anesthetist will listen to your preferences and make a knowledgeable recommendation that is best for you. The decision will also consider the surgeon’s requirements for the best outcome of your surgery. The anesthetists and surgeons work closely together as a team for you.

Why should I choose regional anesthesia?

There are many advantages of regional anesthesia compared to general anesthesia: 

  • With regional anesthesia, your anesthetist can give you less or no opioids (morphine-like drugs). Decreasing the amount of opioid medication and of general anesthesia decreases the side-effects such as nausea, and vomiting. 
  • With regional anesthesia, you will have a decrease or absence of pain after surgery.
  • With regional anesthesia, you will have a smoother and more natural transition from surgery and the operating room, to the recovery room and/or your hospital or home.
  • Regional anesthesia can allow you to do rehabilitation exercises earlier. This is beneficial for recovery because when you put your muscles to work, they pump blood better and thus improve blood circulation  
  • Regional anesthesia may reduce the risk of formation of blood clots, heart attacks, lung complications, and admission to the intensive care unit (ICU). 
  • Regional anesthesia may prevent you from developing chronic pain after surgery. 
  • With regional anesthesia, you can bypass the recovery room (awakening room) altogether and go directly to your hospital room or home. 
  • With regional anesthesia, you can eat and drink quickly after the surgery, and you are much less likely to be nauseous or vomit after drinking and eating.
If I choose regional anesthesia, does that mean that I will be awake during the surgery?

NO. Choosing regional anesthesia does not mean that you have to be awake during your surgery. If you are anxious about seeing or hearing the medical staff during surgery, you should notify your anesthetist. The anesthetist can give you medications to make you lightly asleep and less anxious during the procedure (this is called sedation). 

There are three common levels of sedation:

  • Mild sedation: The anesthetist will give you medications that will make you feel relaxed even when you are awake. With mild sedation, you can understand and answer questions and will be able to follow instructions. 
  • Moderate sedation: The anesthetist will give you medications in an adjusted dose so that you feel relaxed. Although you will sleep lightly you can be easily awakened when spoken to or touched. You may hear the sound and voices of your doctors and nurses around you, but will not be anxious. You may not even remember being in the operating room (OR). 
  • Deep sedation: With the deep sedation, you typically sleep through the procedure with little or no memory of the OR until the medications wear off. 

All our patients have the option of receiving headphones with calming music of their choice during the operation. Music decreases anxiety and is beneficial during surgery. It is important that you know that whatever the plan your anesthetist makes for you at the time of anesthesia and surgery, the plan can always be changed quickly, and medications can be adjusted to give you comfort and the best experience of anesthesia and surgery.

Does getting regional anesthesia hurt?

Most medical interventions result in a certain level of discomfort. However, receiving regional anesthesia should not be an unpleasant experience. Our anesthetists routinely use medications to make you feel comfortable during the administration of regional anesthesia. 

Before performing spinal, epidural anesthesia, or a nerve block, your anesthetists will apply numbing medicine to anesthetize your skin. This will feel like an initial prick but will decrease the discomfort during the rest of the procedure. During the administration of spinal or epidural anesthesia, you may feel a tingling sensation in the area of the hip or down the leg. Once the spinal or epidural anesthesia is given, you will gradually begin to feel warmth in your legs, followed by a loss of sensation and ability to move your legs. Once the medications wear off, you will regain sensation and movement.

How long does the numbness last?

The duration and intensity of the numbness depend on the type of numbing medication that your anesthetist chooses, as well as whether you receive the medication once or have a catheter for repetitive doses. Typically,  it can last from a few hours to several days.

What are the risks or complications of regional anesthesia?

Every medical intervention carries a risk of complications. Risks specifically related to regional anesthesia do not occur frequently. Some of those specific risks are infection at the injection site, headache, nerve injury, and toxicity of local anesthetics.

.

Regional Anesthesia Pathways for Patients Having Orthopedic Surgery

If you are having orthopedic surgery, this is the path that you will follow in our hospital: 

1. Arrival at the preoperative area

When you arrive in the preoperative area, a team of nurses will greet you, check your medical file, and ask you some security questions. Do not be concerned as our staff members may repeatedly ask you the following security questions:

  • What is your name?
  • What is your date of birth? 
  • What procedure will be performed (and on what side)? 

After the security check confirmation, you will be dressed in a hospital gown, and a nurse will place an (intravenous) IV line in your hand or arm. This is necessary for the safety and administration of IV fluids and medications. 

2. Arrival at the N-block room to meet your nurses and anesthesiologist 

When the operating room is ready for you, your nurse will transfer you from the preoperative area to the N-block room. Here, your anesthetist will introduce him/herself, perform another security check, and explain the anesthesia procedures planned for you with their respective benefits and risks. The anesthetist will have the information you have already given during the preoperative consultation. The anesthetist will also answer all your questions and listen to your preferences before choosing the best anesthetic plan for your surgery.

3. Getting ready for the block

The anesthetist will administer the regional anesthesia 30-60 minutes before the operation. The anesthetist will first clean your skin with a cleaning solution and administer some medication through your IV line to relieve tension and anxiety. 

4. The block procedure 

Depending on the location of surgery, regional anesthesia may be in the shoulder-arm, back, or leg regions. The regional anesthesia procedure is selected specifically for you and the type of operation to provide anesthesia for the surgery.
(see below the specific information according to your surgery)

Commonly, your anesthetist will use an ultrasound machine to identify the correct place of needle insertion. Once the correct location is selected, the numbing medication (i.e., local anesthetic) is administered. The administration of regional anesthesia typically takes a few minutes (10-15 minutes). If you experience any discomfort during this time, you should communicate it to your anesthetist, who will then adjust the procedure and/or level of medication to your comfort.

After the numbing medication is administered, you will gradually begin to feel the loss of sensation in the area where the regional anesthesia was applied. 

5. The surgery

When the surgeon and his team are ready, they will meet you at the N-block room and perform an additional security check. After their security check, you will be transferred to the surgery room. Your anesthetist will work with you to adjust the medication to your desired level of awareness. If you prefer – you can be completely awake, or lightly asleep. Your anesthetist will be with you at all times to assure your safety and comfort during the operation. If you experience discomfort or pain, you can get additional medication. 

6. After the operation

Once your operation is completed, you will be transferred to the recovery room. Here, you will be cared for and watched carefully to make sure that there are no complications of the operation and/or anesthesia. This step usually takes a couple of hours. Once the recovery room staff rules out any complications, you will be transferred to your room to continue recovery. If you were planned for day surgery and feeling well, you will be sent home as soon as you feel ready. With many procedures done under regional anesthesia, patients can go home the same day, shortly after the surgery.

.

Regional Anesthesia Pathways for Patients for Specific Surgeries