Regional Anesthesia

I spent the last month on my regional anesthesia rotation, our immersion into nerve blocks. I'm one of the last residents in my year to do regional anesthesia. Although I got the usual pre-rotation jitters starting something completely new, I quickly got the hang of it and had a great month. Nerve blocks are primarily used for orthopedic surgeries, though we do them for a wide variety of procedures, from nephrectomies to mastectomies to open hysterectomies. Some are done specifically for post-operative pain, like a femoral nerve block for knee replacements. Others are intended to be the primary anesthetic, such as numbing an entire arm for wrist surgery. Although much of the focus of the rotation was becoming proficient in the procedures, regional anesthesia has many other facets that encompass systems based practice, operating room efficiency, understanding surgical requirements, and managing patient follow-up.

The concept of regional anesthesia is simple. If the surgery is localized to a specific area innervated by specific nerves, then blocking those nerves with local anesthesia will be sufficient for the surgery (or for post-operative pain management). It requires much less amount of medicine than the surgeon infiltrating local anesthesia indiscriminately. And it may make general anesthesia unnecessary. Thus, a good sense of anatomy and peripheral nerves is all a regional anesthesiologist needs to devise a plan of action.