Patient Information

Regional Anesthesia Frequently Asked Questions

What can I expect on the day of surgery?

On the day of surgery, you will meet with an anesthesiologist to evaluate whether regional anesthesia is the right option for you. If it is, the regional anesthesiologist will perform your nerve block approximately ½ to 1 hour before your surgery.  Generally, the blocks are performed in a specialized area dedicated to regional anesthesia. We will provide you with medicine to help alleviate any anxiety and will monitor your vital signs throughout the procedure. There are several methods that can be used to locate the nerves including ultrasound and electrical stimulation. Sometimes a combination of both methods is used. After locating the nerves, we inject the numbing medication, and your limb will become anesthetized over the next 10 to 20 minutes.

Regional Anesthesia: Regional anesthesia involves injecting numbing medicine around the peripheral nerves that innervate certain portions of your body. We perform these procedures so you will not feel pain during, or immediately after, your procedure. Depending on the specific numbing medicine (local anesthetic) we use, the “nerve block” can last even longer, ranging from hours to days. For specific types of surgery, we place a catheter, which can continuously bathe the nerve in numbing medicine for an average of two to three days.

There are many advantages to regional anesthesia. Because you have less pain, you need less pain medicines by mouth or IV, even though you will still have the same medicine prescriptions available to you. In addition, patients who receive regional anesthesia have less nausea and recover more quickly after surgery.

We often combine regional anesthesia with either intravenous sedation or general anesthesia, both of which allow you to “sleep” during surgery.  You will have the opportunity to discuss your preferences with your anesthesiologist prior to surgery. There are always risks associated with performing any procedure. Fortunately, serious complications associated with regional anesthesia are exceedingly rare.

At UCSD, the Regional Anesthesia Division specializes in performing nerve blocks for patients undergoing surgery and for post-operative pain. The training program in Regional Anesthesia at UCSD is the only one of its kind in the state of California, recognized by the American Society of Regional Anesthesia.

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Options for Hand Surgery

For minor hand/wrist surgeries such as carpal tunnel release, we use intravenous regional anesthesia (also known as a “Bier block”) which involves placing a second IV catheter in the hand undergoing surgery. We inject numbing medicine in the venous system which gets trapped by a tourniquet and diffuses around the nerves. The numbness is very short-lived so we only use this technique for minor surgeries.

For more extensive surgeries involving bones and/or joints, we perform nerve blocks at different locations depending on the site of surgery (finger, hand, or wrist) and the site of the surgeon’s tourniquet.  Nerve blocks for hand and wrist surgery are most commonly performed in the axilla (“axillary block”) or at the shoulder (“infraclavicular block”).

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Options for Elbow or Forearm Surgery

For surgeries involving the elbow, nerve blocks are most commonly performed in the axilla (“axillary block”) or at the shoulder (“infraclavicular block”).

Options for Upper Arm or Shoulder Surgery

For surgeries involving the upper arm or shoulder, nerve blocks are most commonly performed in the area around your collarbone (“interscalene block”). For extensive arthroscopic shoulder surgery and shoulder replacement, we routinely place a catheter near the nerves which can deliver numbing medicine into the area for 2-3 days. This type of pain relief facilitates your rehabilitation and reduces your need for other pain medications.

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Options for Knee Surgery

For surgeries involving the knee, nerve blocks are most commonly performed at the groin (“femoral block”). For ACL reconstruction and knee replacement, we routinely place a catheter near the nerves which can deliver numbing medicine into the area for 2-3 days. This type of pain relief facilitates your rehabilitation and reduces your need for other pain medications.  In addition to a femoral nerve catheter, we may perform an additional nerve block behind your thigh (“sciatic block”).

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Options for Hip Surgery

For hip surgery, nerve blocks may be performed in the back to numb the nerves responsible for sensation of the hip joint (“lumbar plexus block”) or an epidural may be placed. A lumbar plexus block is different than an epidural because a lumbar plexus block only numbs the nerves to one side.

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Options for Foot or Ankle Surgery

For surgeries involving the foot or ankle, nerve blocks are most commonly performed in the area behind your knee “popliteal sciatic block”) or at the level of the ankle (“ankle block”).

For more invasive surgeries of this area (for example, tendon/ligament repairs and fractures), we routinely place a catheter near the nerves which can deliver numbing medicine into the area for 2-3 days. This type of pain relief facilitates your rehabilitation and reduces your need for other pain medications.

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Options for Facial Surgery

For surgeries involving the face and neck, it may be possible to perform specific nerve blocks to minimize your postoperative pain.  Common procedures that are suitable for nerve blockade include endoscopic sinus surgery, septoplasty, and rhinoplasty.Your anesthesiologist will discuss these options with you on the day of surgery and determine if you are a good candidate for nerve blockade.

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Duration of Numbing Medicine

The intensity and duration of your block largely depends on the type of numbing medicine (local anesthetic) that was used, as well as whether you receive a single dose of medicine or have a nerve block catheter in place. As a single dose, some local anesthetics provide a couple hours of numbness, others can provide numbness that lasts up to a day.

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Nerve Block Catheter

A nerve block catheter is a skinny tube placed near your nerves in order to continuously bathe your nerves with numbing medicine. The catheter is attached to a machine (“pain pump”) the size of a portable CD player. This pain pump is filled with local anesthetic which continuously delivers numbing medicine through the catheter in order to provide you with pain relief for 2-3 days. Once the medicine runs out, the catheter is removed. Removal is a simple procedure that you or a caretaker can do at home. The Regional Anesthesiology Service will follow up with you daily (by phone if you’re at home) and be available for any questions you may have regarding the catheter.

Catheters are more suitable for certain surgeries and sites than others. Your anesthesiology team will help determine whether this is a good option for you.

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Pain from a Nerve Block

Getting a nerve block is no more painful than getting an IV. We numb the skin before placing the nerve block and can also provide you with mild sedation prior to the procedure.  

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When to Perform the Nerve Block

Although any of these procedures can be performed under general anesthesia, doing so prevents you from giving us feedback as we work around your nerves. Placing the nerve block while you’re “awake” (but comfortably sedated) adds an additional measure of safety to the procedure.

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Risk involved in getting a nerve block

As you know, any procedure has associated risks.  However, the risk of any serious complication as a result of nerve blockade is very small.  We perform this procedure in a sterile manner to minimize the risk of infection. The possibility of trauma to the nerves exists, but is extremely remote.

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