Regional anesthesia

Last updated: January 11, 2023

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Regional anesthesia involves the injection of local anesthetic agents around nerves in the peripheral nervous system or central nervous system to achieve reversible numbing of pain conduction in the corresponding innervated tissue. Regional anesthesia can be divided into peripheral nerve blocks, neuraxial anesthesia (i.e., spinal anesthesia, epidural anesthesia), and intravenous regional anesthesia.

See also “Local anesthesia” and “Local anesthetic agents.”

Definition [1]

Injection of local anesthetic agents around nerves in the peripheral nervous system to achieve reversible numbing of pain conduction in the corresponding innervated tissue

Indications [1]

General

Head, neck, and thorax

Common nerve blocks of the head, neck, and thorax [1]
Type Targeted nerves Clinical applications
Maxillary nerve block
Mandibular nerve block
  • Inferior alveolar nerve
  • Mental nerve
Intercostal block

Upper extremity

Common nerve blocks of the upper extremities [1]
Type Targeted nerves or plexus Clinical applications
Brachial plexus block
  • Interscalene plexus
  • Supraclavicular plexus
  • Infraclavicular plexus
  • Axillary plexus
Elbow or wrist block
Digital block
  • Digital nerve

Lower extremity

Common nerve blocks of the lower extremities [1]
Type Targeted nerves Clinical applications
Femoral block (three-in-one block)
Fascia iliaca block
Sciatic block
Ankle block
Digital block

Contraindications

See “General contraindications to regional anesthesia.”

Procedure [1]

  • Injection site: varies based on the target nerve
  • Approach
    • Single injection
    • Continuous administration via a catheter
  • Technique: varies based on the target nerve

Complications

See “Complications of regional anesthesia.”

Peripheral nerve blocks do not carry the risks associated with general anesthesia (e.g., respiratory depression, aspiration) and neuraxial anesthesia (e.g., CSF leak syndrome, urinary retention). [1]

Avoid discharging patients after major nerve blocks until sensation and function have returned to baseline levels to reduce the risk of secondary injury. [1]

Monitor for delayed-onset LAST, especially if high doses of local anesthetic agents were used.

Definition [2]

Indications [2]

Contraindications [2]

See also “General contraindications to regional anesthesia.”

Procedure [2]

Complications

See “Complications of regional anesthesia” and “Complications of neuraxial anesthesia.”

Definition

Indications

Used for a variety of lower extremity, lower abdominal, pelvic, and perineal procedures (e.g., cesarean delivery, hip and knee replacement), e.g:

Contraindications

See “Contraindications” in “Epidural anesthesia.”

Procedure

  • Injection site
  • Approach: almost always single-shot technique

Complications

See “Complications of regional anesthesia” and “Complications of neuraxial anesthesia.”

See also “Adverse effects of local anesthetic agents.”

Complications of regional anesthesia [1]

Complications of neuraxial anesthesia [3][4][5]

Total spinal anesthesia [6]

We list the most important complications. The selection is not exhaustive.

  1. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018
  2. Turnbull DK, Shepherd DB. Post-dural puncture headache: pathogenesis, prevention and treatment. Br J Anaesth. 2003; 91 (5): p.718-729. doi: 10.1093/bja/aeg231 . | Open in Read by QxMD
  3. Clinical Relevance of the Bezold–Jarisch Reflex. http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1943118. Updated: May 1, 2003. Accessed: February 20, 2017.
  4. Schrock SD, Harraway-Smith C. Labor analgesia.. Am Fam Physician. 2012; 85 (5): p.447-54.
  5. Asfaw G, Eshetie A. A case of total spinal anesthesia. International Journal of Surgery Case Reports. 2020; 76 : p.237-239. doi: 10.1016/j.ijscr.2020.09.177 . | Open in Read by QxMD
  6. Ronald D. Miller, Manuel Pardo (Jr.). Basics of Anesthesia. Elsevier Health Sciences ; 2011
  7. Agabegi SS, Agabegi ED. Step-Up To Medicine. Wolters Kluwer Health ; 2015

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