Regional Anesthesia

In regional anesthesia, only a specific part of the patient’s body is anesthetized or numbed, so the patient does not feel pain in that area. There are several types of regional anesthesia, and the method chosen by the anesthesiologist depends on the type of surgery.

For surgeries performed at MD Medicina, we most often use spinal or subarachnoid anesthesia and various blocks of specific major nerves or nerve plexuses (such as the popliteal block, interscalene block, etc.). In spinal or subarachnoid anesthesia, the anesthesiologist injects a local anesthetic into the spinal canal (an injection in the back at waist level). The anesthetic surrounds the nerves emerging from the spinal cord and supplying the surgical area. This results in numbness of the body below the navel, or sometimes only of the left or right leg. This type of anesthesia is suitable for all types of surgeries below the navel: hip, knee, ankle surgeries, various urological procedures, cesarean sections, etc. During the operation, the patient feels nothing and may remain awake and even watch the procedure on a monitor (e.g., knee arthroscopy), or doze during the surgery. After the procedure, sensation and strength in the anesthetized part of the body return after a certain period, usually within two to four hours (depending on the type of local anesthetic used).

In nerve block or plexus block procedures, a local anesthetic is injected near major nerves or nerve plexuses under ultrasound guidance, resulting in numbness of a specific part of the body or limb (e.g., arm, foot). In this type of regional anesthesia, the patient may occasionally feel that something is happening at the surgical site, but it is not painful. The effect of the local anesthetic wears off gradually; for example, after a hallux valgus surgery, the foot may remain numb until the next day, which is desirable as it prevents postoperative pain. While the leg (or arm) is numb and the patient cannot feel it, they must be very careful not to injure themselves and should follow the anesthesiologist’s instructions given upon discharge.

For certain surgeries, a combination of regional and general anesthesia may be used. For some minor procedures, the surgeon may decide to use only local anesthesia, meaning that the surgeon will personally inject a local anesthetic into the surgical area and then perform the operation. In local anesthesia, the anesthesiologist is not present. The patient does not feel pain, but is aware that something is happening. The amount of local anesthetic that can be injected into the surgical field is limited due to its potential toxic effects if it enters the bloodstream, which is why local anesthesia is not suitable for larger surgeries.

At the patient’s request, in addition to regional or local anesthesia, a sedative (for relaxation, drowsiness, or light sleep) may be administered to help them better tolerate the surgical procedure. This is known as sedation (calmness with preserved consciousness). The sedative is usually given intravenously, and throughout the procedure, the patient remains drowsy but responds appropriately to commands, questions, or touch, while not feeling any pain. The anesthesiologist monitors the patient continuously during the procedure and administers additional sedatives if needed.