Risks and benefits of regional anesthesia

1. What are the benefits of a regional block?

Frequently, there is less nausea from regional blocks and patients generally awaken faster after regional blocks. Regional blocks can also be used to reduce the pain after surgery. Generally, regional nerve blocks and catheter will provide better pain control than intravenous or intramuscular opioids (narcotics).

Epidural analgesia for pain control after surgery might provide you with some specific benefits:

  • Better pain control than intravenous narcotics,
  • Earlier recovery of bowel function,
  • Less need for systemic opioids (narcotics) and less nausea as a result,
  • Easier breathing resulting from better pain control,
  • Easier participation in physical therapy

2. What are the risks of a regional anesthesia block?

Like any other medical procedures, there are risks associate with regional anesthesia. Complications or side effects can occur, even though you are monitored carefully and your anesthesiologist takes special precautions to avoid them. To help prevent a decrease in blood pressure, fluids may be administered intravenously. Although not common, a headache may develop following the block procedure. By holding as still as possible while the needle is placed, you may help to decrease the likelihood of a headache. The area where the nerve block was administered may be sore or tender for a few days. These discomforts, if they do occur, often disappear within a few days. If they do not disappear or become severe, additional treatments are available.

There are veins in the epidural space and other areas where epidural nerve blocks are administered. There is a risk that the anesthetic medication could be injected into one of them. To help avoid unusual reactions stemming from this, it is important to notify your doctor or nurse immediately if you notice any dizziness, rapid heart beat, funny taste or numbness around your mouth.

Nerve blocks of the brachial plexus are generally well tolerated but there may be signs and symptoms that you may notice. You might experience a change of your pupil size on the affected side, this is called Horner's syndrome. You also might experience a light drop of your eyelid (ptosis). These are normal reactions which typically go away after the nerve block is gone. You might experience a stuffy nose and may experience a certain degree of hoarseness. 
You might have the feeling that you might have to make a stronger effort to take deep breaths because one of the nerves going to your diaphragm will be affected as part of the normal block. An important, although very rare, complication of the cervical paravertebral, interscalene, or infraclavicular blocks, is the development of a pneumothorax (air trapped between the lung and the rib cage). In the unlikely case you do develop a pneumothorax, you may not notice any changes immediately but you might develop respiratory symptoms like persistent coughing, chest pain, or problems breathing and shortness of breath within 24 hours after performance of the block. If any of those symptoms occur you should contact your anesthesiologist or your nearest emergency room immediately. An x-ray will confirm the diagnosis of pneumothorax and sometimes the evacuation of the air with a chest tube is necessary. Because this is a rare but serious side effect, you should be aware of those symptoms.

Any time a needle or catheter is inserted under the skin and near a blood vessel, bruising, infection, or bleeding may occur. An uncommon complication of the axillary approach to the brachial plexus can be the formation of large hematomas. You should notify your anesthesiologist about any expanding hematoma in the puncture area immediately. 
The specific risks of anesthesia vary with the particular procedure and the condition of the patient. You should ask your anesthesiologist about any risks that may be associated with your particular anesthesia. Your anesthesiologist carefully evaluates your condition, makes medical judgments, takes safety precautions and provides special treatment throughout the procedure. You should feel free to talk with your anesthesiologist about your options for anesthesia, pain control after surgery, their benefits and their possible side effects.

a. What is a spinal (postdural puncture) headache? What are the treatments for spinal headache? 

A spinal or postdural puncture (PDPH) (or also sometimes called a meningeal puncture headache) may occur after spinal or epidural anesthesia when puncture of the dural sac allows for spinal fluid to leak out of the dural sac. If enough spinal fluid leaks out, a headache may occur especially when standing or sitting. A spinal headache may occurs any time after spinal or epidural anesthesia but most cases generally show themselves within 3-5 days after a spinal or epidural anesthetic. The characteristics and severity of the headache may vary. With improvements in needle design, the risk of a spinal headache after anesthesia is much less than a few decades ago.

If you have a headache after spinal or epidural anesthesia, you need to contact your surgeon or primary care physician if you are at home or notify the health care providers caring for you if you are still in the hospital. If you are at home and do not have a physician contact person, you should be evaluated at an emergency room. There are many possible causes for headache other than spinal headache from spinal or epidural anesthesia and your physician may need to examine you and perform several tests to see what is causing your headache.

If your headache is the result of spinal or epidural anesthesia, then there are several treatment options depending on the severity of your symptoms. If your headache is mild, treatment is conservative and includes taking oral pain-relieving medications, drinking fluids, and consuming caffeine (usually in the form of caffeinated beverages). The leaking puncture will normally repair itself in a few days-weeks and your symptoms will gradually improve. If your symptoms are severe or your symptoms do not improve, your anesthesiologist may recommend an "epidural blood patch" . This involves carefully takes a small amount of blood from one of your veins and injecting it into the epidural space in your back. The injected blood in the epidural space will form a clot and seal the puncture site. After the epidural blood patch, your spinal headache should improve within 12-24 hours. If after this time period, you still have symptoms compatible with a spinal headache, your anesthesiologist may recommend repeating the epidural blood patch one more time. Your anesthesiologist will discuss the balance between the risks and benefits of an epidural blood patch.

b. How common is nerve injury after a regional block? 

Nerve injury after a regional block is a rare occurrence, which can occur anywhere from 1 in 4000 blocks to 1 in 200.000 blocks depending in the type of block and specific risk factors. It can be related to direct needle injury of the nerve or to secondary complications like bleeding or infection. In order to prevent nerve injury, please inform your anesthesiologist if you experience any sharp or radiating pain during needle placement or injection. If you experience any new symptoms like tingling, numbness, or motor dysfunction after a nerve block has already worn off you should seek medical attention immediately because this can be a sign of secondary damage by hematoma or infection. Because recovery of nerve function depends on timely initiation of diagnosis and treatment, do not take any unexpected changes lightly.

c. Can the epidural or regional block catheter become infected? 

Every time a foreign body like a needle or catheter is introduced into your body, there is the risk of infection. Bacteria can enter the body through the primary puncture or along the catheter site. The risk of infection increases over time but the chance of a serious infection leading to abscess formation and requiring surgical intervention or damage to the nerve secondary to an infection is extremely rare.

Careful monitoring of the catheter insertion site is required to detect early signs of infection. Redness, swelling and purulent discharge should lead to immediate inspection of the catheter site and removal of the catheter. While most often no other treatment than removal of the catheter is required, sometimes systemic antibiotics might be administered or surgical drainage of an abscess can be necessary. Abscess formation in the epidural space is extremely rare bit it can be a very dangerous complication leading to permanent paralysis. If you experience any fevers or chills, one of the described local symptoms or any change in your neurologic status like increased numbness or loss of motor function, bladder and bowel disturbances, you need to contact you anesthesiologist or health provider immediately.

3. Will I receive a separate bill from the anesthesiologist?

Your anesthesiologist is a physician specialist like your surgeon or internist, and you will receive a bill for your anesthesiologist's professional service as you would from your other physicians. If you have any financial concerns, your anesthesiologist or an office staff member will answer your questions. You will note that your hospital charges separately for the medications and equipment used for your anesthetic.

Many people are apprehensive about surgery or anesthesia. If you are well-informed and know what to expect, you will be better prepared and more relaxed. Talk with your anesthesiologist. Ask questions. Discuss any concerns you might have about your planned anesthetic care. Your anesthesiologist is not only your advocate but also the physician uniquely qualified and experienced to make your surgery and recovery as safe and comfortable as possible.

NOTE: Material on this page does not constitute medical advice. Consult with your physician concerning specific medical conditions.