Samuel Seelig (Anesthesiologist, Los Angeles, California) gives expert video advice on: When is local anesthesia most often used? and more...
When is local anesthesia most often used?
Local anesthesia is most often used on small operative procedures. A small amount of local anaesthetic is placed by the surgeon at the operative site and he does a "field block" of the area that he will be inspecting, excising or biopsying. It is not necessary to have an anaesthesiologist present during many local anesthetic procedures. However, the patient will still be monitored with the same monitoring devices as if an anaesthesiologist is present, because adverse reactions can occur with the local anaesthetics. The patient may have a vasovagal reaction or a panic reaction, and thus become faint, dizzy, or nauseous. The patient can have a reaction to the local anaesthetics, and the patient can have a panic reaction in the operating room, so it's important to monitor them and to be ready for anything that might occur.
Are all local anesthetics administered in the same way?
Local anaesthetics can be administered in many different ways. It can be used by the surgeon just in a small field block in the area that he will exsize. Local anaesthetics are also used during regional anaesthetic techniques, whether it be spinal or epidural or caudal, it will be placed in the spinal canal in a small concentration to make the patient numb from the waist down. It will be used in larger volumes in the epidural space to accomplish the same area of numbness, or it can be placed in the caudal canal to operate on the paranium itself. It can be given locally or it can be given in the neuraxis in the epidural and spinal canal. Local anesthetics can also be given intravenously. Some procedures on the extrremities the arms and the legs can be performed with what they call a "beer block". A tourniquet is placed on the extremity which is then ensanguined. It is wrapped tightly so that the blood in the vessels is pushed out, the tourniquet is inflated and the the vessels are filled with local anaesthetics. The local anaesthetic will defuse into the extremity and make it numb for surgical intervention.
What are the advantages of regional anesthesia?
The advantages of regional anaesthesia are first and foremost the lack of manipulation of the patient's airway. If you can provide analgesia or anaesthesia to a limb or to the lower torso, you can allow the patient to breathe spontaneously and have a patient airway in that manner. The patient can still be sedated and/or asleep, but you do not have to place any device in the windpipe or in the upper airway. Specifically, the greatest advantage of regional anaesthesia is in the laboring mother. She can be made comfortable during her entire labor so that she can enjoy the labor and communicate with her family. It is also safe for the baby.