Regional Anaesthesia for your operation

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					                                                                             What are the benefits of nerve blocks?

                                                                             With a regional block, you may, if you wish, avoid a general anaesthetic
                                                                             altogether. This may be good if you have certain medical problems, e.g.
                                                                             bad asthma or diabetes. It also means that you are less likely to be sick
                                                                             after surgery and can eat and drink straightaway.

                                                                             Nerve blocks also provide good pain relief after the operation. You may
                                                                             help us to assess the effectiveness of the pain relief by grading any
                                                                             discomfort you feel, on a scale of 0-10, where 0 is no discomfort and 10 is
Regional Anaesthesia for your operation                                      the maximal pain.
                                                                             Regional blocks can also reduce blood loss during surgery.
This leaflet will answer most of your questions and should be read
together with the leaflet “Pain relief after your operation”, which is       What if I do not wish to be awake during the operation?
available from the Pain Control Team at the Nuffield Orthopaedic
Centre.                                                                      That is okay. You can go to sleep for the operation. Your anaesthetist can
                                                                             either send you into a light sleep using a sedative, from which you are
What is Regional Anaesthesia?                                                rousable and unlikely to remember the operation, or can send you into a
                                                                             deep sleep (general anaesthesia). In fact, peripheral nerve blocks for leg
Regional anaesthesia means numbing the area of operation, such as the        and foot surgery are usually performed under general anaesthetic.
leg or the hand, by using local anaesthetic drugs to block the nerves
which supply this area.                                                      How is a peripheral nerve block procedure performed?

Local anaesthesia means “freezing” the exact area of surgery with local      Usually, the doctor will insert a plastic tube into a vein before performing
anaesthetic. Sometimes both terms are used loosely to describe the same      the nerve block. The doctor will clean the relevant area and feel for the
thing.                                                                       correct position before inserting a special nerve block needle.

What regional anaesthesia techniques are used for orthopaedic                Typically, a nerve block needle is a narrow blunt needle, with a special tip,
operations?                                                                  which allows a small electrical current to pass so that a muscle will twitch
                                                                             when the needle is near the nerve. This current is so small that it will not
For operations below the waist, such as hip or knee surgery, the             be painful. However, you may feel a "pins and needles" sensation and also
anaesthetist can either use central regional blocks, which numb the          find that your hand or foot is moving by itself.
nerves in the back, e.g. epidurals or spinals, or peripheral nerve blocks,
which numb the nerves in the legs, e.g. femoral and sciatic blocks. For      How is a central nerve block performed?
operations on the hand, arm or shoulder various upper limb peripheral
blocks can be used to numb the area, e.g. axillary (injection in the         Again, the doctor will insert a plastic tube into a vein before performing an
armpit), wrist or finger blocks.                                             epidural or spinal. You may be asked to sit up or lie on your side, curling
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up and pushing your back out “like an angry cat”. The doctor will then          Yes, risks exist with any form of anaesthesia. However, regional
clean your back and feel for the correct position in your back. The skin        anaesthesia is very safe and in certain patients is safer than general
will be numbed with the local anaesthetic before inserting an epidural or       anaesthesia. Most of the problems with nerve blocks are temporary.
spinal needle. It is important to remain still when this is done.               Sometimes the nerve block fails to work as well as we wish. In this case
                                                                                the block may be repeated or, if this is not possible, different pain relief
The doctor may thread a fine epidural tube (catheter) through the needle        will be used as described in “Pain relief” leaflet.
into a special space in your back. This tube can be used for ongoing
postoperative pain relief.                                                      A common side effect is temporary weakness or paralysis of the numbed
                                                                                leg or arm and you have to be careful as advised above. Prolonged
A spinal is performed in a similar way with the difference that no catheter     numbness or weakness due to nerve damage occurs extremely rarely.
is inserted. Sometimes both techniques are combined.
                                                                                Together with the nerves, there are many arteries and veins. Very rarely,
What is the main effect of nerve blocks?                                        enough local anaesthetic drugs may enter the system from the vessels and
                                                                                nerves to cause heart rhythm disturbances, dizziness, fits, unconsciousness
Doctors inject local anaesthetic drugs into the vicinity of nerves. These       or even for your heart to stop beating.
drugs cause a temporary block of the normal functions of these nerves, i.e.
sensation and movements. This allows us to reduce and even stop pain.           That is why major nerve blocks are performed in an area with oxygen,
The ability to move is also temporarily impaired.                               drugs and equipment. Experienced anaesthetists carry out the procedure
                                                                                and they are trained to prevent, recognise and manage all complications.
How long does it take for my feeling and movement to return to
normal?                                                                         Are there any specific problems with central nerve blocks?

This varies from person to person and depends on the type of block. We          Yes. While carrying out an epidural or spinal, a bruise may result and
may expect nerve functions to take up to 24 hours to return after a single      cause pain in the back. An epidural or spinal does not usually cause long-
injection block, whether it is a spinal or a peripheral block. Sometimes a      term backache.
catheter is inserted in the vicinity of nerves to provide continuous infusion   A small number of people (0.5-1%) may develop a specific headache
of local anaesthetic after your operation. In this case numbness will last
                                                                                caused by an epidural or spinal, which may occur in the first few days
for as long as infusion continues.                                              after the block and needs to be reported to your doctor.
During this time, you have to be careful as you may not feel pain when          Your blood pressure may fall, you also may feel sick or itchy. This can be
touching sharp or hot objects. You may also not be able to move your            easily corrected with fluids and drugs.
limbs accurately and may fall on your numbed leg or hit yourself
accidentally with your numbed arm.                                              Occasionally, some people may not be able to pass urine and may need a
                                                                                catheter to be inserted to help empty the bladder.
Are there any side-effects or complications of the peripheral nerve             How can I decide which block is better for me?
blocks?
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This leaflet gives you basic information to help make an informed choice
later. Your final decision should be made after discussion with your
anaesthetist who will see you before your operation and obtain your
consent.

Where can I get further information about regional anaesthesia?

We recommend that you talk to your anaesthetist or a trained nurse. You
can also find more information on the Internet. The site, which you may
find helpful, is the American site www.oyston.com/anaes/ local.html.

However, please note that your anaesthetist’s experience and preference
are major success factors for your regional anaesthesia and that is why the
final decision should be made together with him or her.


       Authors
       Drs Michael Lim, Graham Burt, Svetlana Rutter;
       Nuffield Department of Anaesthetics
       Dawn Abbott, Senior Nurse;
       Pre-admission Clinic 01865 227519

        Nuffield Orthopaedic Centre

       January 2004, version 1; review January 2005




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