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Local anesthesia (regional, peripheral) is a method of blocking pain transmission, it is a completely reversible method and widely used in medicine. The main difference between this type of anesthesia and general anesthesia is the patient's full awareness. Find out if local anesthesia is safe and when it can be used.

Local anesthesia , especially superficial anesthesia, is a safe procedure, currently it is difficult to imagine any serious interference without inhibiting the pain sensation.

Current medical knowledge allows for pain-free treatments and safe methods of abolishing it.

The doctor responsible for anesthesia - general, blockages, spinal and epidural is an anesthesiologist, while surface anesthesia is performed by each doctor.

Local anesthesia includes:

  • surface anesthesia
  • nerve blocks
  • spinal and epidural anesthesia, i.e. "in the spine"
  • segmental intravenous anesthesia

Depending on the indications, these anesthesia can be combined with each other, as well as with short intravenous anesthesia or with full general anesthesia ("anesthesia").

Local anesthesia - surface

Surface anesthesia is by far the most common, it is most often performed on an outpatient basis in dental procedures, in emergency departments or surgical clinics.

Skin anesthetics are the most commonly used lignocaine, rarely bupivacaine and novocaine, sometimes with the addition of adrenaline, which constricts the vessels and reduces the absorption of the substance, and the duration of anesthesia is longer then.

These substances are available in several forms and therefore the methods of their application may be different: from gels and creams for the skin, mucosa and in the eye, through an aerosol form in the throat (for anesthesia, e.g. before gastroscopy), to a solution for injection.

The last route of administration is the most effective and common. This type of anesthesia is also called infiltration or infiltration anesthesia.

This method involves giving a small amount of the drug by injection (subcutaneously, intradermally or intramuscularly) atthe area where the treatment will be performed.

The great advantage is the possibility of anesthesia in exactly the place that requires anesthesia, and the amount of the administered agent can be used to regulate the power of pain relief, so that the procedure is as comfortable as possible.

The characteristic of local anesthesia is that it blocks only pain, remember that feeling in the place is preserved.

So we feel that something is happening in a given area of ​​the body, it is normal and it does not mean that the agent does not work or that it was incorrectly administered.

Local anesthesia only inhibits the pain sensations, awareness of course is maintained.

The effect of anesthetics starts after a few minutes and lasts, depending on the type of substance administered, from 1 to 2 hours.

A very important aspect of infiltration anesthesia is its safety - side effects practically do not happen, and if they do occur, they are harmless.

What is equally important, for such analgesia you do not need preparation, you do not need to fast (unless the procedure itself requires it).

However, you should remember and always report to your doctor that you are allergic to this type of anesthesia, in which case it cannot of course be used.

Failure to inform about an allergy can be disastrous, as administering the drug to such a patient may lead to respiratory, circulatory and shock disorders.

Sometimes the effect of anesthesia is weaker in places where there is a strong inflammation, because in such areas the reaction of the tissues is altered, so that the drug is unable to penetrate into the nerve fibers and act in them.

Complications of local anesthesiaare extremely rare, most often when too much agent has been used or when more of it has been accidentally injected into the vessel. These symptoms, however, pass quickly, and include:

  • heart rate disturbances - heart rate and strength of contractions
  • pressure drop
  • feeling of a metallic taste in the mouth
  • numbness of the tongue
  • dizziness
  • visual disturbance
  • tinnitus
  • muscle tremors and convulsions

A type of local anesthetic is alsosegmental intravenous anesthesia , it is rarely performed. It allows to anesthetize the entire limb and consists in injecting the anesthetic into the venous vessels of the limb, from which the blood has previously been transferred outside the area of ​​the agent's action.

Local anesthesia "in the spine", i.e. spinal and epidural

Another essentialoften used local anesthesia is the subarachnoid administered to the subarachnoid space of the lower part of the spinal canal, which is popularly called "in the spine".

The applications are numerous, they are usually short operations, such as :

  • orthopedic and surgical procedures of the lower limbs
  • knee arthroscopy
  • urological treatments
  • varicose vein surgery
  • gynecological operations
  • cesarean section.

In the latter case, it is the most frequently chosen method. It is also not uncommon that this anesthesia is preferred in patients with numerous diseases for whom general anesthesia may be dangerous or contraindicated.

The onset of subarachnoid analgesia is immediate and lasts from 1.5 to 4 hours, which is a great advantage of this type of anesthesia, as it provides a pain-free period immediately after the procedure.

In addition, this method enables contact with the patient during the operation, he may then e.g. report disturbing symptoms, agree to change the scope of the procedure, and in the case of a cesarean section, the mother has the opportunity to see her baby immediately after birth.

Moreover, thanks to the fact that the patient breathes independently, the risk of complications of intubation used during general anesthesia is eliminated.

It is also believed that spinal anesthesia has a positive effect on coagulation, preventing thrombotic changes.

For many people it is important that the procedure can be carried out in the so-called one-day mode, if it is not very serious.

Observation of the patient after spinal anesthesia is much shorter than after general anesthesia, thanks to which the patient can leave the hospital soon after the procedure.

Contraindications for spinal anesthesia are:

  • no consent to such anesthesia;
  • very low pressure, shock. Such anesthesia often leads to a drop in pressure, which in such cases can be dangerous;
  • severe blood coagulation disorders, including taking anticoagulants, as a puncture in the vicinity of the meninges may lead to subarachnoid bleeding;
  • skin infections at the injection site, this is a very important contraindication, because the infection cannot be transferred from the skin to the meninges;
  • tattoo at the injection site, it is a contraindication for a similar reason as infection, the needle may transfer small amounts of dye from the skin to the cerebrospinal fluid, which can be very seriousconsequences;
  • some heart diseases - heart failure, valvular disease;
  • some neurological diseases;
  • severe headache and backache;
  • osteoporosis and discopathy in the section where anesthesia will be administered;

Spinal anesthesia is much safer than general anesthesia, but in this case also side effects may occur, such as :

  • pressure drop and heart rate drop, to prevent them an intravenous drip is used during anesthesia;
  • headache and back pain after anesthesia, so-called post-dural headaches, their risk can be minimized by lying flat for 8 hours after the procedure;
  • nausea and vomiting;
  • temporary urination disorder;
  • subarachnoid hematoma;
  • infection;

It is a common myth that you experience paralysis after such anesthesia, it is not true, you cannot move your legs during the anesthetic, but the sensation is transient and the limb function returns to its full extent after the drug has ceased to work.

Another type of anesthesia administered "into the spine" isepidural . Technically, it is much more difficult to perform, the anesthetic is also administered to the spinal canal, but outside the meninges, around the nerves that run there, and not inside the arachnoid, as under the anesthesia described earlier.

In addition, the action starts later, after about half an hour. An important difference is also the fact that in this type of anesthesia, a 1mm tube is inserted into the epidural space. Thanks to this, it is possible to administer an anesthetic many times, so it is used in the chronic treatment of: postoperative pain, labor pains or in the course of cancer. In the case of surgery, however, it is used alone or in combination with general anesthesia.
This type of anesthesia is also not free from complications, they are rare, and are very similar to those that can occur after spinal anesthesia.

Local anesthesia - blockades

Nerve blocks are most often performed on the brachial plexus, the nerves of which supply the entire upper limb, and this blockade provides anesthesia for the entire arm. In addition, anesthesia is also performed around the wrist to numb the hand and around the ankle to numb the foot. It can be used in many other anatomical locations. It is often helpful to use a special stimulator with which the doctor can trace the course of the nerve. Middleis administered in the area of ​​plexuses or individual nerves, thanks to which the pain is not felt, unfortunately it also causes temporary exclusion of the anesthetized part of the body from functioning. This method is used, for example, after orthopedic surgery, then there is no need to take strong painkillers. Of course, this anesthesia is completely reversible.

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Category:

Neurology