University of Maryland Rehabilitation & Orthopaedic Institute
410-448-2500 or 1-888-453-7626

Programs and Services

Anesthesia Services

Patient Education


What is Local Anesthesia

Having a procedure performed under "local anesthesia" involves having numbing medicine (local anesthetic drugs) injected to a specific area of the body, such as a tooth or an area of skin. It numbs only the area near the injection. Local anesthetics are the most common drugs used in the dental office and the numbness may last a few hours.

top

What is Regional Anesthesia?

"Regional anesthesia" (also known as spinal, epidural, or nerve block) involves having an injection of local anesthetics near a bundle of nerves to numb the area of your body that requires surgery. It "blocks" the sensation in a specific part of your body both during and immediately after surgery. A spinal or epidural can be performed to numb the lower half of the body for specific surgical operations below the waist, such as knee and hip surgery or cesarean section. Local anesthetic medications are injected into your back while you are sitting upright or lying on your side. Similarly, one of your arms or leg can be anesthetized in a variety of ways. For some types of surgery, you may receive an infusion catheter, which is a soft, thin tube which can be connected to a numbing medicine infusion for a few days.

top

What are Peripheral Nerve Blocks?

"Peripheral nerve blocks" are specialized regional blocks that can be performed as a single injection of numbing medications, or as a continuous infusion through a soft, thin tube. Your anesthesiologist will discuss with you which type of block is best for you. For single injection nerve blocks in general, the numbness may last 6-12 hours. Much longer numbness, up to 24-36 hours is not uncommon for certain lower leg blocks. As the nerve block "wears off," a feeling of "pins and needles" may be experienced. The hospital staff will instruct you on what type of peripheral nerve block you have had and how to take your pain medications before the block wears off.

top

Peripheral Nerve Techniques:

The Kernan Hospital Anesthesiology Division employs the use of ultrasonography to visualize targeted nerves for peripheral nerve blocks. The concept of ultrasound imaging incorporates the body's ability to reflect sound waves from a probe that is placed where the nerve block will be performed. The probe receives the reflected waves and an image is created on the ultrasound machine. This ensures correct placement of the block around the nerve. Your anesthesiologist will administer medication to relax you prior to numbing the area.

top

Interscalene Block

An interscalene block can be used for anesthesia during surgery to the shoulder or upper arm. You will have your vital signs monitored and the anesthesiologist will usually administer a small amount of sedation prior to performing the block. You will be positioned comfortably on your back and nasal oxygen will be given to you. Your neck will be cleansed with an antiseptic and an ultrasound machine will be at your side. The numbing medicine will be given and the surgeon will begin surgery once your arm is numb. At the end of surgery, your sedation will wear off and you may notice that you are unable to move or feel your shoulder, arm, or maybe your hand. This is normal and may last several hours. The hospital staff will set up a medication schedule for you to help with pain control once the surgical block wears off. An infusion of numbing medication may be connected to a catheter that is taped in place to help with pain control after your surgery.

top

Infraclavicular Block

An infraclavicular block can be used for anesthesia during surgery to the lower shoulder or lower arm. You will have your vital signs monitored and the anesthesiologist will usually administer a small amount of sedation prior to performing the block. You will be positioned comfortably on your back and nasal oxygen will be given to you. Your neck will be cleansed with an antiseptic and an ultrasound machine will be at your side. The numbing medicine will be given and the surgeon will begin surgery once your arm is numb. At the end of surgery, your sedation will wear off and you may notice that you are unable to move or feel your shoulder, arm, or your hand. This is normal and may last several hours. The hospital staff will set up a medication schedule for you to help with pain control once the surgical block wears off. An infusion of numbing medication may be connected to a catheter that is taped in place to help with pain control after your surgery.

top

Femoral Block

A femoral nerve block can be used for anesthesia during surgery to the knee and upper leg. You will have your vital signs monitored and the anesthesiologist will usually administer a small amount of sedation prior to performing the block. You will be positioned comfortably on your back and nasal oxygen will be given to you. Your groin area will be cleansed with an antiseptic and an ultrasound machine will be at your side. The numbing medicine will be given and the surgeon will begin surgery once your leg is numb. At the end of surgery, your sedation will wear off and you may notice that you are unable to move or feel your thigh, knee, or foot. This is normal and may last several hours. The hospital staff will set up a medication schedule for you to help with pain control once the surgical block wears off. An infusion of numbing medication may be connected to a catheter that is taped in place to help with pain control after your surgery.

top

Sciatic Block:

A sciatic nerve block can be used for anesthesia during surgery to the knee and upper leg. You will have your vital signs monitored and the anesthesiologist will usually administer a small amount of sedation prior to performing the block. You will be positioned comfortably on your side and nasal oxygen will be given to you. Your buttock area will be cleansed with an antiseptic and an ultrasound machine will be at your side. The numbing medicine will be given and the surgeon will begin surgery once your leg is numb. At the end of surgery, your sedation will wear off and you may notice that you are unable to move or feel your thigh, knee, or foot. This is normal and may last several hours. The hospital staff will set up a medication schedule for you to help with pain control once the surgical block wears off.

top

Popliteal Block:

A popliteal nerve block can be used for anesthesia during surgery to the ankle and foot. You will have your vital signs monitored and the anesthesiologist will usually administer a small amount of sedation prior to performing the block. You will be positioned comfortably on your stomach and nasal oxygen will be given to you. Behind your knee will be cleansed with an antiseptic and an ultrasound machine will be at your side. The numbing medicine will be given and the surgeon will begin surgery once your leg is numb. At the end of surgery, your sedation will wear off and you may notice that you are unable to move or feel your lower leg or foot. This is normal and may last several hours. The hospital staff will set up a medication schedule for you to help with pain control once the surgical block wears off. An infusion of numbing medication may be connected to a catheter that is taped in place to help with pain control after your surgery.

top

Home Care for Nerve Catheters:

Your anesthesiologist will discuss with you how to care for a peripheral nerve catheter at home if it is decided that this therapy is beneficial for your recovery. A family member should also be available to help with your care at home.

top

Your Pre-Anesthesia Consultation - Deciding which type of anesthetic technique is best for you

In the preparation area in the post-anesthesia care unit, a member of the anesthesiology team will discuss with you your options for anesthetic techniques.

Your medical history and pre-operative blood tests will be reviewed, along with the benefits and risks of the techniques offered. It is important to review with the anesthesiologist any medical conditions, current medications and herbal remedies that you are currently taking. If you are sensitive to certain medications, especially those prescribed for pain, it is important to notify the medical team so that your postoperative recovery can be planned with alternative medications.

top

The Acute Pain Management Service (APMS)

Nurse Coordinator: Cathy Bower, BSN, RN-BC

Following surgery, your pain control is an important component to your recovery. During your hospital stay, a specially trained nursing team is available to coordinate your postoperative pain. Our goal is to provide safe and effective pain management for our surgical patients.

The APMS is under the direction of the Kernan Anesthesiology Division and Pain Management Center. Nurses with expertise in post-operative pain control closely monitor the patient's status and deliver pain control medications through specialized computer pain pumps. Many patients following surgery have either continuous epidural or continuous peripheral nerve infusions on the Medical Surgical Unit. The nursing staff will monitor the patient's pain level using a pain scale, 0-10. When pain levels become unacceptable, actions are taken to improve pain control.

A multi-modal regimen is used postoperatively at Kernan Hospital. Patients receiving nerve block infusions may have a PCA (Patient-Controlled Analgesia) machine or start taking opioid "pain reliever tablets" before the nerve block completely wears off. Ice therapy also complements the pain control plan.