This is a type of anesthesia that has been around for many years. Spinal anesthesia is one of the oldest anesthesia techniques used for surgery. In the past it was common to use this for urologic procedures (procedures of the bladder). A small needle is carefully inserted in the low back and into the spinal canal. A very small amount of medication is then injected. This will then allow that part of the body to become numb and surgery can then take place. It was very effective but because of a lack of understanding, it was accompanied by side effects like spinal headaches. Over time it has been refined with the use of new equipment, medications and techniques and this makes it much safer and produces good results. In the case of urologic procedures this compares well to general anesthesia.
Today, regional anesthesia techniques using nerve blocks are very common and allow us to perform many surgical procedures with mild sedation when in the past they required a general anesthetic. The most common surgeries in which we use such techniques are orthopedic procedures on the extremities. Usually a small needle is used to deliver medications to nerves that supply the arm or leg. Once the medications are delivered, the area the nerve supplies becomes numb and often the procedure can be performed with minimal sedation. Today these nerve blocks are performed with the aid of ultrasound and a nerve stimulator. Be sure to discuss these with your anesthesia provider before you are sedated.
It is common to use an epidural as a supplement to the general anesthesia. The epidural allows placement of a small catheter near the spinal canal to give medications. These will anesthetize the nerve endings in that area. The location of the epidural placement is very important. It will usually be placed so that it numbs the area were surgery is performed. For example, with chest surgery the epidural is placed in the area of the mid-thoracic spine, whereas for an abdominal procedure it will go in the lower thoracic spine. The medications used are usually a combination of local anesthetic medications and a narcotic. This will give good additional pain control and often intravenous narcotics will not be required after surgery.
When these techniques are used effectively they can result in a good experience. Patients often awaken quickly and have minimal pain.