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Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Regional Anesthesia [Read/Print full article]
Overview
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When you need a surgical procedure, one of the main responsibilities of your anesthesia team is to provide an anesthetic plan that aims to keep you as safe and comfortable as possible. In general, the type of anesthesia that we will recommend for you depends on both the type of surgical procedure you are having and specific aspects of your current medical condition, including your age, current and past health, and current medications.
A regional anesthetic helps block pain in a region or area of the body, such as your lower body, abdomen, leg, or arm. It differs from the surgeon's use of local anesthetic infiltration at the surgical site, which usually decreases the pain only at the direct area around the incision and is generally suitable for only minor procedures. It also differs from general anesthesia, which is characterized by the induction of a state of unconsciousness through the administration of anesthetic medications into the bloodstream through either an intravenous line or by inhalation or both.
Depending on which type of regional anesthetic is chosen, it may be given either centrally near the spine or tailbone, or peripherally, targeting a specific nerve or set of nerves that numbs the area of the body where the surgery will be performed. It is given either as a single injection or continuously through a small catheter that is placed at the site. Local anesthetic medication is primarily used to achieve pain relief or temporary numbness during and/or after the surgery. For safety, most regional anesthesia is performed with patients mildly sedated but awake so that the patient can cooperate and provide feedback. Depending on the type of local anesthetic used, the numbness and accompanying pain relief will wear off in a matter of hours to days.
Why It Is Done
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If the surgery location and type allow it, an anesthesia plan including regional anesthesia may be recommended to help with pain relief during and/or after the surgery. It can be used as the primary anesthesia for the surgery or used in conjunction with other types of anesthesia. If offered in place of general anesthesia, this type of anesthesia may allow you to remain conscious during your procedure and receive less medication through your bloodstream to the rest of your body.
Other reasons to consider regional anesthesia as opposed to general anesthesia include:
- Fewer side effects from medications
- Less risk of complications during your recovery period in some cases
- Quicker recovery in the postoperative care unit (PACU) in some cases, so you can return home quickly after surgery
- Better overall pain control that works differently than narcotic pain medicine with fewer side effects
Before Your Procedure
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There are a number of things we will want to do before you have your surgery. Preparations will include the following:
Preop visit
There are several things we will want to discuss with you before your anesthesia. During the planning stages, we will first gather information regarding your medical and surgical history in order to assess your anesthetic risks. Then we will work with you to find a safe and comfortable anesthetic plan. We are particularly interested in the following:
- Medications, supplements, or herbs you are currently taking. We may ask you to stop taking anything that is a blood thinner (for example, aspirin or Coumadin) 7 to 10 days before the procedure. Be sure to ask us when to stop taking certain medications. Some medications need to be stopped up to a week before your procedure; others can be stopped on the day of the procedure.
- Pregnancy, even the possibility that you could be pregnant.
- Anesthetic-related reactions during previous procedures. We would also like to know if a blood relative has had a major reaction to anesthetic.
- Allergies to medications.
- Health conditions, including heart and lung problems, liver or kidney disease, a bleeding disorder such as hemophilia, or sleep apnea.
- Smoking status. If you smoke, stopping smoking prior to your surgery has beneficial effects. We can refer you to smoking cessation resources to help you quit.
The day before the procedure
- Arrange for a responsible friend or family member to drive you to and from the hospital or clinic.
- Be sure you have received and follow instructions on what medications to take or not take.
- Do not eat or drink anything after midnight unless instructed otherwise. This includes alcohol.
- Confirm time and place of procedure.
The day of the procedure bring:
- Kaiser Permanente Membership Card
- Photo ID
- Slip-on shoes
- Something to read (while waiting)
What You Can Expect
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When you arrive, you will be asked to change into a medical gown to allow access to the area of your procedure. A peripheral intravenous line, or IV, will be placed prior to the start of your anesthesia and surgery.
For safety during the placement of your regional anesthetic, you will be attached to a monitoring machine that traces the rate and rhythm of your heart as well as your blood pressure and the amount of oxygen in your blood.
For most regional anesthetic blocks, we will offer you an additional sedative and pain reliever to help you relax. If these are necessary, we usually give them intravenously. If sedation is used, breathing oxygen through a mask or nasal cannula (oxygen through tubes in your nose) may be recommended for added safety.
Next we will disinfect the injection area. For many of these blocks, we now use ultrasound technology to help locate the exact spot to place the needle.
There are 2 main types of regional anesthesia:
Central neuraxial anesthesia
This refers to a spinal block, also known as subarachnoid block (SAB), and epidural block. Spinal anesthesia is usually performed as a single injection of local anesthetic medication in the fluid that bathes the nerves of the lower body for procedures of the lower abdomen, hips, or legs. An epidural anesthetic may be performed as a single injection, or a catheter may be placed to lengthen the duration of effect. In this case, the medication is placed in a space just outside the spinal canal to numb the nerves of a particular region, usually the chest, abdomen, or lower extremity, as they exit from the spinal canal.
Peripheral nerve block
Femoral (top of the thigh), popliteal (back of the knee), axillary (upper arm), and interscalene (junction of neck and shoulder) nerve blocks are just a few of the more common peripheral nerve blocks that we perform for surgeries of the knee, foot, arm, and shoulder, respectively. Local anesthetic medication can be given as either a single injection or continuously through a catheter. It is particularly useful for decreasing postoperative pain.
During the block
To prevent discomfort associated with the placement of the regional block needle in the correct area, a small amount of numbing medicine will first be injected with a very small needle. If you still feel any pain, please let us know, as this information can help us make you more comfortable and guide us safely when we are near your nerves.
The local anesthetic medication will gradually numb the area after placement of the block, and you may also not be able to move this region of your body. If your lower abdomen and lower extremity are affected, you also may not be able to control your bladder. In this case, a urinary catheter may be placed after you are numb to drain your bladder.
Throughout the block, we carefully monitor your vital signs.
After your surgery
When the surgery is completed, you will recover in the recovery room. Typically, spinal blocks wear off in a few hours, and single injection peripheral nerve blocks take 6 to 24 hours to wear off. You may feel tingling as the sensation returns to the area of the regional anesthetic. It is important to remember that while the surgical area remains numb, extra caution is needed to protect that area from injury. You can expect muscle strength in that area to return as feeling returns, and we will give you special instructions concerning use of the areas of your surgery, especially any weight bearing, with your discharge instructions.
Risks
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Although regional anesthesia is generally safe, there are always risks or complications associated with every intervention. These may include a headache that gets worse with standing (after spinal or epidural anesthesia).
Very rare complications include:
- Allergic reaction to the anesthetic medicine
- Toxic reaction to the anesthetic medicine (seizure, heart rhythm disturbance)
- Infection or bleeding at the area of injection
- Nerve damage
After Your Procedure
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Depending on the surgery you are having and the type of regional anesthesia that is performed, you may return home after the initial effects of the anesthesia wear off.
For the next 24 hours, we recommend that you follow any specific care instructions and do not:
- Drive
- Lift or operate heavy equipment
- Drink alcohol
Monitor your health and watch out for:
- Signs of infection including redness, fever, or chills
- Continuing headache or back pain
- Problems with bladder or bowel control
- Prolonged numbness or weakness
If you believe you are experiencing an emergency, call 911 or go to the nearest Emergency Room.
Related Health Tools:
Podcasts
- Successful Surgery Successful Surgery
Prepare for Your Procedure
- Anesthesia for an Adult (Emmi) Anesthesia for an Adult (Emmi)
- Taking Warfarin (Coumadin®) (Emmi) Taking Warfarin (Coumadin®) (Emmi)
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.