When surgery is on the arm or shoulder, we can do different types of upper extremity blocks. If surgery is being performed on the body below the waist, we can perform one of a variety of lower extremity blocks. The specific block will be discussed and agreed upon between the patient, anesthetist and anesthesiologist prior to surgery.
Interscalene block is used for anesthesia for shoulder surgery. This renders the shoulder completely numb and without sensation. This block is primarily used for post operative pain relief and can last up to 24 hours. The block is performed prior to the surgical procedure, and the surgery itself is done under general anesthesia.
Axillary block is used for surgery on the forearm and hand and is also performed prior to surgery. The surgery is then performed under sedation with the operative site completely numb. This technique can also last up to 24 hours, giving good postoperative pain relief.
Bier block is a technique that was first introduced in the late 1800's and named after Dr. August Bier, the man who discovered it. This technique is used for forearm and hand surgery when the procedure is relatively short and there is no bone involvement. An example would be carpal tunnel release or excision of a ganglion cyst. It involves injecting local anesthetic into the veins of the hand and arm after using a tourniquet to prevent the anesthetic from going throughout the body. Sedation is given along with this technique.
Spinal Anesthesia is administered by placing a needle in the lower back after the skin is numbed with local anesthetic. Once the needle is in the right place, local anesthetic is injected and the needle is removed. The upper and/or lower abdomen and the legs and feet are completely numb after this procedure. Surgery is then performed with the patient receiving sedation. The spinal lasts for about 1½ to 4 hours depending on the type of anesthetic used. Spinal anesthesia is used for Caesarean section, some types of hernia repair, knee or ankle arthroscopy and several other lower extremity procedures.
Epidural anesthesia or analgesia is very similar to the spinal technique, except a catheter may be placed in the spinal interspace, and local anesthetic and narcotic can be continuously infused into the spinal column for up to 72 hours. This technique is most commonly used for delivering babies, but can be used for postoperative pain relief for major abdominal surgeries, and for total knee and hip replacements. Chronic back pain may also be relieved by injecting steroids into the epidural space.