The Andrews Institute ASC has been recognized nationally and internationally for over a decade for its postoperative pain management program using regional anesthesia and minimizing the use of opioids. Several hundred anesthesiologists from around the world have visited over the last 12 years to observe the techniques and approaches of the Andrews Anesthesia team.
Anesthesia is administered to keep you comfortable and pain-free during surgery, medical procedures or tests. However, the type you receive will depend on several factors, including what kind of procedure you have, your health and your personal preferences. The primary types of anesthesia include:
General anesthesia is most commonly used for major operations, such as shoulder, knee and hip surgeries. It is administered by a physician anesthesiologist or certified registered nurse anesthetist (CRNA) through a mask or an IV placed in the vein. The nurse anesthetists and physician anesthesiologists work together as a team at our facility.
While the anesthesia works, you will be unconscious, and many of your body’s functions will slow down or need help to work effectively. A tube may be placed in your throat to help you breathe. During surgery or the procedure, the physician anesthesiologist or CRNA will monitor your heart rate, blood pressure, breathing and other vital signs to ensure they are normal and steady. At the same time, you remain unconscious and free of pain.
Once your surgery is complete, your anesthesia provider will reverse the medication and be with you as you return to consciousness, continually monitoring your breathing, circulation, and oxygen levels. Some patients feel fine as they wake up; others experience nausea, vomiting or chills. Your throat may also be sore from the breathing tube. However, your anesthesia care team and recovery room nurse will help you manage these symptoms.
Because you’ve had major surgery, you probably will have pain and discomfort from the procedure as you recover, which might worsen as the general anesthesia effects wear off. Your physician anesthesiologist will advise you about managing your pain during recovery in the hospital and at home. It may take a day or two for the anesthesia medication to leave your system altogether, leaving you sleepy and your reflexes and judgment affected.
Sedation, also known as monitored anesthesia care, conscious sedation, or twilight sedation, is typically used for minor surgeries or shorter, less complex procedures when an injection of local anesthetic isn’t sufficient but deeper general anesthesia isn’t necessary. These procedures might include some types of biopsies or diagnostic procedures. Provided through an IV placed in a vein, sedation relaxes you and sometimes makes you fall asleep. Often, an analgesic is combined with sedation to offer pain relief simultaneously.
Depending on the procedure, the level of sedation may range from minimal (you’ll feel drowsy but able to talk) to deep (you probably won’t remember the procedure). Moderate or deep sedation may slow your breathing, and in some cases, you may be given oxygen. Analgesia may also contribute to drowsiness. But even with deep sedation, you won’t be unconscious as you would be with general anesthesia. The level of sedation a patient experiences depends on several factors, including the procedure you’re having and how your body responds to anesthesia. Your age, medical condition, and health habits may also affect the type of anesthesia you’ll receive.
Most patients wake up quickly once the procedure is over and the medications are stopped. Possible side effects include headache, nausea, and drowsiness, but you will likely experience fewer effects than you would from general anesthesia — and you’ll probably recover faster and go home sooner. Sometimes IV sedation and analgesics will be combined with other types of pain control — such as local anesthesia, which involves one or more injections to numb a small area of the body, or regional anesthesia, which numbs a larger part of the body, such as from the waist down.
Regional Anesthesia/Nerve Blocks
Regional anesthesia is a type of pain management for surgery that numbs part of the body. Types of regional anesthesia include a spinal block, which numbs the lower half of your body, or a peripheral nerve block, which numbs a select portion of your body, such as your arm or part of your leg. The medication is delivered through an injection or small tube called a catheter. Regional anesthesia is typically used in conjunction with general anesthesia and monitored anesthesia.
What is a Nerve Block?
A nerve block is an injection of a numbing medicine near specific nerves to decrease your pain after surgery. Your anesthesiologist usually performs the nerve block before your surgery. Still, it DOES NOT replace having anesthesia for your surgery, nor does it replace the need for pain medication after your surgery.
Benefits & Purposes of Nerve Blocks
The benefits and purpose of receiving a nerve block include reducing your pain during and after your surgery with minimal use of narcotic pain medications. Narcotics have many common side effects, such as nausea, vomiting, slowed breathing, itching, constipation, and sleepiness. You will lessen the likelihood of unpleasant narcotic side effects by receiving a nerve block and reducing your narcotic intake during and after surgery.
Overall, receiving a nerve block helps get you back to your desired level of activity and prescribed physical therapy sooner and usually provides a more pleasant surgical experience.
Single Shot vs. Continuous Pain Catheter
Your surgeon and the type of surgery will determine if you receive a single shot block or a continuous pain catheter.
A single shot block is a one-time injection of a numbing agent. The duration of the block varies depending on the location of the block and the numbing medication used. Generally, the block may last 12-18 hours or longer, leaving the extremity extremely numb for the duration.
A continuous pain catheter is a thread-like tube placed when your surgeon wants you to receive a local anesthetic for several days. At the time of the nerve block procedure, a single shot injection is performed first, followed by the placement of a catheter (thread-like tube) near the targeted nerves. This thread-like tube will bathe the affected nerves with numbing medicine for several days.
On the day of your procedure, your extremity will be extremely numb. You will not be as numb in the days that follow, but the surgical site should be reasonably comfortable. Before leaving the facility, the catheter is connected to a pain pump filled with numbing medicine. This pain pump will provide pain relief for several days.
Today, many types of surgery can be safely and painlessly performed while you are awake. Local anesthesia, also called local anesthetic, is usually a one-time injection of medicine that numbs a small area of the body. It is used for procedures such as performing a skin biopsy, repairing a broken bone or stitching a deep cut. You will be awake and alert and may feel some pressure, but you won’t feel pain in the treated area. In some cases, local anesthesia is combined with sedation.
Local anesthetics have made it possible to perform many surgical procedures quickly, with less preparation and a shorter recovery time. General anesthesia and anesthesia that sedates you can cause side effects such as nausea. A physician anesthesiologist must monitor you if you are administered these types of anesthesia — during the procedure and for a time afterward.
However, with local anesthesia, side effects and complications are rare and usually minor. For example, you may experience some soreness where the medication is injected. In rare cases, you could have an allergic reaction to the anesthetic.
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