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Anesthesia Associates of Southern Connecticut

Regional Anesthesia

This type of anesthetic involves anesthetising a certain area of the body (a region). There are two types:

  • Intravenous Regional Anesthesia (Bier Block)
  • Nerve Block

BIER BLOCK

bier block

This is an old technique dating back to the turn of the 20th century. It is used almost exclusively for surgery of the lower arm and hand. It is extremely safe and simple to perform.

In addition to the regular IV, a 2nd small IV is placed in the hand on the side to be operated on. Once in the O.R., a tourniquet (that looks exactly like a blood pressure cuff) is placed on the upper arm. The lower arm is then wrapped tightly starting at the fingers and moving toward the tourniquet. The tourniquet is then inflated and the wrap is removed. Lidocaine (a local anesthetic) is injected into the previously-placed IV and this establishes the anesthetic. The IV is then removed and surgery can proceed.

As soon as surgery is over, the tourniquet is deflated, and the numbness in the arm wears off within minutes.



NERVE BLOCKS

Ultrasound image of Interscalene

Nerve blocks have also been in use since the invention of local anesthetics. Virtually any part of the body can be anesthetized with a nerve block. While nerve blocks can sometimes be used as the sole anesthetic, we usually combine the nerve block with either sedation or a full general anesthetic. The primary advantage of nerve blocks is the superb post-operative pain relief they give, usually 12 to 24 hours totally pain-free.

Nerve blocks are widely used at Norwalk Hospital and Fairfield Orthopedic Surgical Center, and our anesthesiologists have a tremendous amount of experience doing them.

In most cases, the nerve block is done with an awake, but sedated patient. The nerves to be blocked are located using high-resolution ultrasound. After local anesthetic, a very fine needle is advanced through the numb area. This needle is attached to a nerve stimulator which delivers a tiny electric current which cannot be felt. When the needle approaches the nerve to be blocked, the nerve is stimulated and causes motion of the limb that it innervates. The patient feels an involuntary motion which is not painful, but can be a little strange-feeling. The anesthetic is then injected through the needle, establishing the nerve block.

The most common blocks are for arm and hand surgery, as well as for knee, ankle, and foot surgery.

  • Interscalene Block - this is the most common nerve block for shoulder surgery. Virtually every shoulder operation done at Norwalk Hospital or Fairfield Orthopedic Surgical Center is done with an interscalene block plus light general anesthesia. The shoulder and upper arm is completely numbed. The elbow and hand are numbed to a variable extent. The success rate of this block is greater than 90%.
  • Infraclavicular Block - this is a block done for elbow and hand surgery. The block is placed just below the collarbone where the bundle of nerves supplying the lower arm are concentrated. The elbow, forearm, and hand are numbed deeply, allowing major surgery to be done on any of these areas.
  • Axillary Block - this is another popular block, and is used primarily for forearm and hand surgery. Some physicians place this block without the aid of a nerve stimulator.
  • Sciatic Block - this block is placed in the buttock area and anesthetizes the sciatic nerve, which is responsible for sensation to a large portion of the leg. Combined with a femoral block (below), it can completely anesthetize the leg and allow major surgery to the knee or lower leg and foot.
  • Femoral Block - this block is placed in the groin and is widely used to treat postoperative pain at Norwalk Hospital and Fairfield Orthopedic Surgical Center. The femoral nerve is responsible for sensation to the front of the knee. This block is extremely easy to perform and can be done in a sleeping or heavily sedated patient. It is used for post-operative pain relief for most ACL repairs and total knee replacements. Because the sciatic nerve is not blocked, there may be some postoperative pain in the back of the knee, but the pain is drastically reduced from the pain felt without the block.
  • Popliteal Block - this block is placed in the back of the thigh about 5 inches above the knee. It blocks the sciatic nerve and is used for ankle surgery and some foot surgery.
  • Ankle Block - this block is performed in a patient undergoing foot surgery. It involves injection of the 5 nerves supplying the foot. Because of the number of injections, this block is done after the patient is heavily sedated and unaware of the injections.
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