Where can partial anesthesia be performed everywhere?

A partial anesthesia can be used in many ways. For example, in gynaecological and obstetrical procedures (often epidural or spinal anaesthesia for caesarean section or vaginal delivery). A partial anaesthetic is also frequently used for operations on the extremities (arms/legs).

This is especially true for operations on the shoulder joint or for implantation of a new knee or hip joint. When implanting (“inserting”) a new knee or hip joint as a combination with general anesthesia. Dental treatments are also often performed with “local anesthesia“, i.e. infiltration anesthesia.

Intravenous regional anesthesia is suitable, for example, for short procedures in the area of a foot or hand. Depending on which intervention on the arm is to be performed, different methods are used. Among others, an arm plexus anaesthesia (“Plexus brachialis blockage”), an intravenous regional anaesthesia or a local anaesthesia of the area to be anaesthetized.

In local anesthesia, the local anesthetic is injected under the skin, e.g. in the area of the wound edges around a cut. In intravenous regional anesthesia, after the blood has been wiped from the arm and the arm has been temporarily ligated, the drug is injected into the vein, thus numbing the arm. In the case of the so-called “arm plexus anaesthesia” or “brachial plexus blockage”, the nerve plexus, which is essential for the supply of the arm, is anaesthetized by an injection after prior local anaesthesia.

In the area of the legs there are various options for partial anesthesia. With local anesthesia, a local anesthetic is superficially injected under the skin. There is also intravenous regional anesthesia.

Here, the blood is first drained from the corresponding leg, creating a so-called “bloodless” condition. Then the leg is tied off and the anesthetic is injected into the corresponding vein.After the procedure, the air-filled cuff is slowly opened to set. In case of a peripheral nerve blockage, anesthetic is injected into the area around the corresponding nerve.

The “sciatic nerve” (nervus ischiadicus) and the femoral nerve with its corresponding divisions are essential for the treatment of the leg. Partial anesthesia using a so-called femoralis catheter is used as follows.

First, the femoral nerve in the groin is searched with the help of ultrasound.
If necessary, the correct position is additionally checked with an electrical nerve stimulator.
If the tip of the needle is in the correct position, the quadriceps femoris muscle (front of the thigh, movement in the area of the kneecap, etc.)
twitches.
Then the thin tube (the pain catheter) is inserted, fixed and the local anaesthetic is injected over it.
In addition, local anesthetic can be administered through this catheter beyond the actual procedure.
This means that fewer painkillers are needed, which act throughout the body (tablets, intravenous injections, etc. ).
After a few days the catheter can be removed.

Spinal anaesthesia/lumbar anaesthesia belongs to the procedures of partial anaesthesia close to the spinal cord or central conduction anaesthesia. The aim is to achieve a safe, fast and reliable blockade/anaesthesia of the spinal nerve roots.

This results in the reversible (reversible) elimination of pain, sensation of touch, mobility and the effect of the sympathetic nervous system in the area to be operated. The puncture site lies below the third lumbar vertebra. Here, surrounded by cerebrospinal fluid (liquor), “only” the roots of the spinal nerves are located.

In the area above, however, the compact spinal cord is located. Therefore, punctures below the third lumbar vertebra can be performed safely. After thorough disinfection and local anesthesia, the patient is asked to prevent the back from becoming a so-called “cat’s back” (hunchback).

The puncture needle is advanced through the hard meninges (dura mater) into the so-called subarachnoid space/liquor space. Then the local anesthetic is administered. During the entire procedure the patient is permanently monitored (ECG, blood pressure measurement, pulse measurement, measurement of oxygen saturation).

In most cases, there is a feeling of warmth immediately after the puncture and injection of the anesthetic. Within a few minutes, numbness, freedom from pain in this area and inhibition of movement follow. The spread of the anesthetic and the duration of the spinal anesthesia depends directly on the patient’s position (influence of gravity), the choice of medication (different density) and the dose.

Depending on the selection and control of this type of anaesthesia, the partial anaesthesia can spread to the thoracic vertebrae, which means that many different operations can be performed with it. In case of a caesarean section (Sectio caesarea), two methods of partial anesthesia can be used. A spinal anaesthesia or a peridural anaesthesia (PDA) (synonym: epidural anaesthesia).

With both methods the pregnant woman remains conscious. In contrast to the rarely used general anesthesia, this allows her to see her newborn baby in the operating room immediately after birth. In spinal anaesthesia, the local anaesthetic is injected directly into the room where the cerebrospinal fluid/spinal fluid is located.

In the case of epidural or peridural anaesthesia, the injection is “only” advanced into the epidural/peridural space. This is a physiological space in the spinal column, which is formed by the inner and outer sheets of the hard meninges. If a particularly rapid onset of action is required, spinal anesthesia is generally preferred. In the case of epidural or epidural anesthesia, a so-called pain catheter can be inserted and fixed in place. In addition, painkillers can then be administered to this region even after the procedure.