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Peripheral regional anesthesia

In peripheral regional anesthesia we block specific nerves or a plexus (bundle) of nerves supplying a specific region of the body by the use of an anesthetic agent (local anesthetic).

We identify the specific nerves with the aid of a nerve stimulator or by ultrasound guidance.

Upper extremity (hand, arm shoulder)


During operations in the arm or shoulder, the nerve (brachial plexus) can be blocked at various sites, depending on the operative field.

Plexus anesthesia in the arm is suitable for interventions in the arm and the hand. It is usually very effective even without additional anesthesia. A local anesthetic is administered either in the armpit or under the clavicle.

For an operation in the shoulder, the pain catheter is inserted on the side of the neck (interscalene plexus block). Usually this procedure is combined with general anesthesia.

Brachial plexus anesthesia


The brachial plexus is a plexus of nerves formed by the branches of the spinal nerves of the last four cervical segments and the first thoracic segments. One part lies above the clavicle and another below the clavicle. The nerve fibers that mainly supply the arm pass through the armpit.

Axillary block


The axillary block is suitable for operations in the forearm and the hand. It eliminates your perception of pain only in the arm. You remain conscious but will feel no pain. In case you are very anxious and would rather sleep, you can be given a tranquilizer additionally.

Procedure
  • You will lie on your back
  • Your arm will be bent 90° at the shoulder and the elbow
  • The region of the armpit and the upper arm will be washed with sterile solution and covered with sterile drapes
  • You will then be given a local anesthetic in the region of the injection site
  • Based on anatomical landmarks, we localize the nerves with the aid of a nerve stimulator or an ultrasound device
  • The nerve stimulator is an electric pulse generator connected to a cannula and emits weak electric impulses. These impulses cause involuntary muscle twitches in the forearm and thus signalize correct positioning of the cannula
  • Alternatively, the nerve can be localized with the aid of a high-resolution ultrasound device and the local anesthetic can be applied specifically to the nerve under visual monitoring
  • After clear identification the local anesthetic will be administered. This may cause a transient sensation of pressure or warmth
  • The effect starts after 15 to 20 minutes, depending on the drug used
  • The blocked area becomes warm and numb, and the arm cannot be moved or its movement will be limited for several hours
Side effects

In rare cases a person may experience discomfort after regional anesthesia. During the entire operation and postoperatively in the recovery room, you will be monitored continuously by your anesthetist and our anesthesia nursing staff - as we do after general anesthesia as well.

At a personal informative consultation before the operation we will inform you about potential risks.

Contraindications

Infections or tumors at the injection site

Infraclavicular brachial plexus block


The infraclavicular block is suitable for operations in the upper arm and the elbow. It eliminates your perception of pain only in the arm. You remain conscious but will feel no pain. In case you are very anxious and would rather sleep, you can be given a tranquilizer additionally.

Procedure
  • You will lie on your back
  • The injection site is in mid-position below the clavicle. The entire region (shoulder, upper arm, chest) will be washed with a disinfectant and covered with sterile drapes
  • You will then receive a local anesthetic in the region of the injection site
  • We will localize the nerves with the aid of a nerve stimulator or an ultrasound device
  • The nerve stimulator is an electric pulse generator connected to a cannula and emits weak electric impulses. These impulses cause involuntary muscle twitches in the forearm and thus signalize correct positioning of the cannula
  • Alternatively, the nerve can be localized with the aid of a high-resolution ultrasound device and the local anesthetic can be applied specifically to the nerve under visual monitoring
  • After clear identification the local anesthetic will be administered. This may cause a transient sensation of pressure or warmth
  • The effect starts after 15 to 20 minutes, depending on the drug used
  • The blocked area becomes warm and numb, and the arm cannot be moved or its movement will be limited for several hours
Side effects

In rare cases a person may experience discomfort after regional anesthesia. During the entire operation and postoperatively in the recovery room, you will be monitored continuously by your anesthetist and our anesthesia nursing staff - as we do after general anesthesia as well.

At a personal informative consultation before the operation we will inform you about special risks.

Contraindications
  • Infections or tumors in the region of the injection site
  • Coagulation disorders
  • The intake of anticoagulant medication
  • The presence of a cardiac pacemaker or a port on the side of the operation

Interscalene brachial plexus block


The interscalene block is suitable for operations in the shoulder and the upper arm. A thin catheter is introduced for postoperative pain treatment. The interscalene block is usually combined with general anesthesia. As the block and the catheter are introduced before the operation, their advantages can be utilized during the operation as well:
  • It reduces the need for anesthetic agents
  • Shortens the recovery time
  • You are free of pain directly after the operation
Procedure
  • You will lie on your back; your head will be slightly turned to the opposite side
  • The injection site is in the lower lateral portion of the neck (picture). This area (throat, shoulder, chest) will be washed with a disinfectant and covered with sterile drapes
  • You will then be given a local anesthetic in the region of the injection site
  • We localize the nerves with the aid of a nerve stimulator or an ultrasound device
  • The nerve stimulator is an electric pulse generator connected to a cannula and emits weak electric impulses. These impulses cause involuntary muscle twitches in the shoulder and thus signalize correct positioning of the cannula
  • Alternatively, the nerve can be localized with the aid of a high-resolution ultrasound device and the local anesthetic can be applied specifically to the nerve under visual monitoring
  • After clear identification the local anesthetic will be administered. This may cause a transient sensation of pressure or warmth
  • A pain catheter will be introduced through the cannula, fixed, and covered with a sterile dressing.
  • The effect starts after 15 to 20 minutes, depending on the drug used
  • The blocked area becomes warm and numb; the shoulder and arm cannot be moved or their movement will be limited for several hours
  • The inserted catheter may remain in place for a few days without difficulties. You can move freely with the catheter and will not feel it because it is very thin. (see Pain therapy)
Side effects

In rare cases a person may experience discomfort after regional anesthesia. During the entire operation and postoperatively in the recovery room, you will be monitored continuously by your anesthetist and our anesthesia nursing staff - as we do after general anesthesia as well.

At a personal informative consultation before the operation we will inform you about potential risks.

Contraindications
  • Infections or tumors in the region of the injection site
  • Severe chronic bronchitis (COPD)
  • Paralysis of the diaphragm on the opposite side

Lower extremity (knee, lower leg, foot)


Depending on the type of operation, various regional anesthesia techniques may be used for operations in the knee, lower leg or foot.

A femoral nerve block is suitable for specific procedures in the knee (knee replacement, cruciate ligament plasty, patella operations).

This type of nerve block is administered in the groin because the nerves that supply the operative field are located at this site. A pain catheter is inserted after the operation for the treatment of pain. The femoral block is always combined with general anesthesia.

Femoral nerve block


When performing surgery in the knee, a femoral nerve block (plus the insertion of a pain catheter) in combination with general anesthesia achieves very effective treatment of pain. As the block and the catheter are introduced before the operation, their advantages can be utilized during the operation as well:
  • Less anesthetic agents are needed
  • Shortens the recovery time
  • You are free of pain immediately after the operation
Procedure
  • You will lie on your back
  • The injection site is in the groin. This region (groin, thigh, abdomen) will be washed with a disinfectant and covered with sterile drapes
  • You will then be given a local anesthetic in the region the injection site
  • We localize the nerves with the aid of a nerve stimulator or an ultrasound device
  • The nerve stimulator is an electric pulse generator connected to a cannula and emits weak electric impulses. These impulses cause involuntary muscle twitches in the thigh and "a dancing patella", thus signalizing correct positioning of the cannula
  • Alternatively, the nerve can be localized with the aid of a high-resolution ultrasound device and the local anesthetic can be applied specifically to the nerve under visual monitoring
  • After clear identification the local anesthetic will be administered. This may cause a transient sensation of pressure or warmth
  • A pain catheter will be introduced through the cannula, fixed, and covered with a sterile dressing.
  • The effect starts after 15 to 20 minutes, depending on the drug used
  • The blocked area becomes warm and numb, and the leg cannot be moved or its movement will be limited for several hours
  • The inserted catheter can be left in place for a few days without difficulties. You will be able to move freely and will not feel it because it is very thin. (see Pain therapy)
Side effects

In rare cases a person may experience discomfort after regional anesthesia. During the entire operation and postoperatively in the recovery room, you will be monitored continuously by your anesthetist and our anesthesia nursing staff - as we do after general anesthesia as well.

At a personal informative consultation before the operation we will inform you about potential risks.

Contraindications

Infections or tumors in the region of the injection site.

Sciatic nerve block


The sciatic nerve block is suitable for operations in the lower leg or the foot. The sciatic nerve block may be used in combination with a femoral nerve block or general anesthesia for any operation in the lower leg. The insertion of a catheter ensures very effective treatment of pain. As the block and the catheter are introduced before the operation, their advantages can be utilized during the operation as well:
  • Less anesthetic agents are needed
  • Shortens the recovery time
  • You are free of pain immediately after the operation
Procedure:
  • You will lie on your back or your side
  • The region of the injection site will be washed thoroughly with a sterile solution and covered with sterile drapes
  • You will then receive a local anesthetic in the region of the injection site
  • We will locate the nerves with the aid of a nerve stimulator or an ultrasound device
  • The nerve stimulator is an electric pulse generator connected to a cannula and emits weak electric impulses. These impulses cause involuntary muscle twitches in the foot and thus signalize correct positioning of the cannula
  • Alternatively, the nerve can be localized with the aid of a high-resolution ultrasound device and the local anesthetic can be applied specifically to the nerve under visual monitoring
  • After clear identification the local anesthetic will be administered. This may cause a transient sensation of pressure or warmth
  • The pain catheter is introduced through the inserted cannula, fixed, and covered with a sterile dressing
  • The effect starts after 15 to 20 minutes, depending on the drug used
  • The blocked area becomes warm and numb, and the lower leg/foot cannot be moved or their movement will be limited for several hours
  • The inserted catheter can be left in place for a few days without difficulties. You will be able to move freely and will not feel it because it is very thin. (see Pain therapy)
Side effects

In rare cases a person may experience discomfort after regional anesthesia. During the entire operation and postoperatively in the recovery room, you will be monitored continuously by your anesthetist and our anesthesia nursing staff - as we do after general anesthesia as well.

At a personal informative consultation before the operation we will inform you about potential risks.

Contraindications

Infections or tumors in the region of the injection site.