Regional anesthetic procedures

Epidural anaesthesia is one of the regional anaesthetic procedures. It is often used for the treatment of chronic pain as well as severe postoperative pain. The epidural is also popular in obstetrics as a pain therapy procedure.

For this purpose the patient is injected with a painkiller into the so-called epidural space, i.e. the space between the sheaths of the spinal canal. The medication is not, as is often assumed, injected directly into the spinal cord. However, it does spread from the epidural space itself to the spinal cord, where it then leads to an anaesthetic of the nerves running there.

Pain medication can be administered once, for example for surgical purposes, but it can also be repeated over and over again via an indwelling catheter. The patient can also control this individually according to his current pain condition. This procedure is then called patient-controlled epidural analgesia (PCEA).

Spinal anaesthesia is similar to epidural anaesthesia and also belongs to the regional anaesthetic procedures. However, the painkiller is injected directly into the space where the nerves of the spinal cord run. In order to prevent the spinal cord from being injured, spinal anaesthesia is only performed in the lumbar region where the spinal cord has already stopped and only the nerves run to the lower extremity.

The nerves are avoided by the needle when the painkiller is injected, so that the risk of injury is low. Spinal anaesthesia is often used for surgical purposes, since under local anaesthesia during anesthesia the need for painkillers after the operation is lower. In addition, the operation is less stressful for the organism, which is particularly important for patients with cardiovascular diseases.

In peripheral conduction anesthesia, certain nerve bundles are specifically blocked with a locally administered analgesic. This is used, for example, in cases where severe pain is expected after surgery. The so-called brachial plexus is a network of nerves in the area of the armpits, which consists of the nerves that supply the arm.

During surgery in the shoulder or arm area, this nerve plexus can be specifically blocked to relieve the patient’s pain. There are various access routes for this purpose, namely directly below the collarbone (infraclavicular access), in the neck area (interscale access) or near the armpit (axillary access). Depending on the location of the intervention, one of the three accesses is chosen.

Then an electric probe is used to determine the optimal position of the needle. For this purpose, electrical impulses are emitted, which lead to the contraction of the musculature when they are delivered in the area of the nerve plexus. Once this position has been found, the painkiller can be applied there.

This is also possible in the form of patient-controlled analgesia, i.e. the patient can use a pump to control when a dose of painkiller is administered again. However, the use of this procedure can lead to a complication of brachial plexus paralysis when nerves are injured. The plexus lumbosacralis is the correlate of the brachial plexus at the lower extremity.

This nerve plexus supplies the legs and pelvic area. When operating on the thigh, knee or lower leg, the lumbosacral plexus can be blocked in the same way as the brachial plexus. For this purpose, the painkiller is injected in the groin area near the large leg artery.