Acute Pain Service

What is Acute Pain Medicine?

What is Regional Anesthesia?

Regional anesthesia is used to numb a large part of your body before, during, and after surgical and some nonsurgical procedures. Regional anesthesia can significantly reduce your discomfort and is a useful option for procedures involving minimal incisions in your chest or abdomen, or for orthopedic procedures involving:

• Your upper extremities (arms, elbows, forearms, hands, and shoulders)
• Your lower extremities (hips, knees, ankles, and feet)

Unlike general anesthesia, you may be lightly sedated during regional anesthesia and remain breathing on your own. This can help you wake up faster with fewer side effects, such as nausea and vomiting.

For some surgical procedures, regional anesthesia is combined with general anesthesia. In this case, regional anesthesia will be most helpful in providing pain relief as you recover in the Post-Anesthesia Care Unit (PACU).

What to Expect

Before your procedure, your anesthesia team will thoroughly review your medical chart and formulate an appropriate anesthetic plan unique to you. We’ll also take time to explain the risks and benefits of regional anesthesia. We encourage you to ask questions so you feel calm and prepared going into your procedure.

During the procedure, your anesthesia team will use state-of-the-art monitoring techniques to ensure your safety and comfort. Your surgeon and anesthesia team will work together closely and discuss any special needs you may have for postoperative care, including a multimodal approach to managing your pain while minimizing opioid use.

Regional Anesthesia Options

When you receive a regional anesthetic, your MedStar anesthesiologist or CRNA will typically numb the area first with a local anesthetic. Next, they will use a special needle to find the perfect location before injecting a local anesthetic near nerves. Your affected body part will feel heavy and numb, and you will feel minimal pain.

Following the procedure, your anesthesia team will continue administering medicine to provide continuous pain relief. In some cases, you will receive numbing medicine through a catheter via a portable pump, with a button that allows you to safely give yourself more medicine as you need it.

Your anesthesia team may use one of the following types of regional anesthesia to help keep you safe and comfortable during and after surgery:

Peripheral Nerve Block – Your anesthesia provider will use a small needle to give you a single injection of medicine near a group of nerves. Depending on the medication, you may experience 12 to 24 hours of pain relief.

Epidural – Similar to a peripheral nerve block, an epidural requires your anesthesia provider to place a thin tube, called a catheter, in your back. The tube remains there throughout the procedure so your care team can deliver medicine as you need it. You will start to feel numb within 10 to 20 minutes and will experience no pain throughout the entire surgery. Following surgery, you’ll continue to receive pain relief medication through the catheter.

Spinal Block – Your anesthesiologist or nurse anesthetist will use a small needle to give you a single injection of medicine. You will feel immediate relief that lasts 2 to 4 hours, depending on the medication used.

Side Effects

Our anesthesiologists and CRNAs are experts in taking precautions to ensure safety and comfort. However, as with any kind of surgical or medical treatment, regional anesthesia may result in side effects. Regional anesthesia complications are rare but may include:

• Decreased blood pressure
• Mild itching
• Headache
• Allergic reaction to the local anesthetic

In the unlikely event of a side effect, your care team will closely monitor you and respond with quick treatment.

Benefits

Regional anesthesia is considered to be part of an Enhanced Recovery after Surgery (ERAS) protocol because of the advantages it has over general anesthesia, including:

• Fewer side effects
• Quicker recovery
• Earlier mobility
• Minimized opioid use

Questions to Ask Your Anesthesia Team

To ease your mind as you prepare for regional anesthesia, you may want to ask your anesthesia team the following questions:

1. How long will it take for the anesthesia to wear off?
2. Am I at risk for any adverse effects from the anesthesia?
3. How will you manage my pain after the anesthetic wears off?
4. Will I be able to drive home, or will I need to arrange transportation?

Core Faculty

Ramon Go, MD, Division Chief
Hiep Dao, MD
Tripali Kundu, MD
Mustafa Ali, MD

Clinical Nurses

Ani Solgat, CRNP
Christina Araneta, CRNP
Kristen Rumcik, RN
Meheza Adja-poroky, CRNP
Mildred Myrtil, CRNP
Tori Hall, RN