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Facing surgery can be a daunting experience fraught with questions, doubt and uncertainties. For many people, anesthesia is the most worrisome aspect.
The good news: Anesthesia is extremely safe today. Additionally, advances in agents and strategies allow the anesthesia provider to work closely with the patient to make the best possible choice. Many procedures that used to require general anesthesia can now be performed with local or regional agents.
“The techniques have been around a long time,” says Dr. Mark Schneider, chair of the department of anesthesiology at Christiana Care Health System. “But they’ve gotten a lot better in the last 10 years.”
Here is an overview of the different types of anesthesia and their applications:
Local Anesthesia
Local anesthesia is an agent that numbs a small part of the body for minor procedures. Topical anesthesia is used for very minor procedures inside the mouth, nose or eardrum as well as most eye surgeries and dermatologic procedures. However, when a large area needs to be numbed, or if a local injection will not penetrate deeply enough, doctors may opt for regional anesthetics.
Regional Anesthesia
Regional anesthesia is used to numb only the portion of the body that will undergo the surgery. Types of regional anesthetics include:
Epidural anesthetic – This technique involves the placement of medications in the epidural space of the spinal column. A catheter is usually placed in the epidural space to deliver medication for several days. Most commonly, an “epidural” is used to relieve pain during labor and delivery. It can also be used for pain management after major chest, abdominal and joint replacement surgeries.
Spinal Anesthetic – A spinal anesthetic delivers an injection of medication into the sac surrounding the spinal column. “Spinals” are typically used for lower abdominal, pelvic, rectal or certain urologic and obstetric procedures such as C-sections.
Peripheral Nerve Block – This technique involves injecting medication directly around nerves to render a specific region or area numb. Advances in ultrasound technology allow the anesthesiologist to visualize many nerves in the body, enabling the placement of medication under direct vision. These blocks are frequently performed for surgery of the knee, shoulder or arm.
Regional anesthetics may be combined with sedation or general anesthesia to minimize side effects while providing a comfortable surgical experience, says Schneider.
Regional vs. General Anesthesia
Regional anesthesia has many advantages compared to general anesthesia. Regional anesthetics are associated with fewer side effects and less postoperative pain. These techniques are also less stressful on the body.
“Any time you can avoid a general anesthesia, it’s a good idea all things considered,” says Schneider. “We’re not as good at monitoring body functions like breathing and blood pressure as the body is itself.”
That said, not every patient has a choice since some surgeries can only be performed with general anesthesia. For example, if you’re having open-heart, cancer or gall bladder surgery, i.e., any procedure where the area is too large to be numbed with a regional anesthetic, you will need a general anesthetic. Some medical conditions, like sleep apnea, will also preclude the use of a regional. Additionally, some patients may be a bit apprehensive about the prospect of using a regional.
“It’s all about informed consent,” says Schneider. “You really need to sit down with the patient and explain to them what’s going to happen and why we’re doing it.”
He tells patients they probably won’t remember anything about the surgery but there is the possibility they might remember the team talking during the procedure.
“If that freaks you out, you probably should consider a general anesthetic,” he says.
