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Regional Anesthesia Program

Regional Anesthesia for surgery

With Regional Anesthesia, the anesthesiologist injects numbing medication (local anesthetic) around nerves that serve the area where your child or teen is having surgery.

There are several kinds of regional anesthesia. These include:

  • Epidural
  • Caudal
  • Spinal anesthesia
  • Peripheral nerve block

What is an Epidural, Caudal or Spinal Anesthesia?

These kinds of anesthesia freeze or numb the chest, abdomen, pelvis or legs. Your anesthesiologist:

  • Injects medication into the spinal fluid or near the spinal canal, which contains the spinal cord and spinal nerves.
  • Places the epidural, caudal or spinal block in the back. This can be done while a patient is awake, sedated or asleep under general anesthesia.

Epidural anesthesia

Epidural anesthesia is usually offered for painful surgeries where patients need several days of pain relief. Your anesthesiologist will place a tiny flexible tube (epidural catheter) in the epidural space
just outside the spinal sac (see the picture below). Your child or teen will then receive numbing medication continuously through this catheter after surgery.

Drawing of horizontal view of a vertebral body with its parts with spinal cord

Drawing of vertical view of a vertebral body with its parts with spinal cord

Caudal anesthesia

Caudal anesthesia is an injection of local anesthetic medication into lowest part of the epidural space, which is some distance from the spinal cord (see the picture below). This is a very common type of block for young children and is helpful for surgeries below the belly button. Patients are usually asleep when they have this kind of injection. It can provide 4-6 hours of pain relief after surgery.

Drawing of the side view of the terminal portion of a vertebral column with a terminated spinal cord in body perspective

Spinal anesthesia

This is a one-time injection of local anesthetic medication in the spinal sac (see the picture below). How long the pain relief lasts will depend on the type and amount of medication given by the anesthesiologist.

When is epidural or spinal anesthesia most helpful?

Epidural or spinal anesthesia is helpful for:

  • Abdominal surgery (stomach, intestines, liver)
  • Gynecologic surgery (female reproductive system)
  • Orthopedics surgery (bone and joint)
  • Thoracic surgery (chest)  Urologic surgery (kidney, bladder and male reproductive system)

What is a Peripheral Nerve Block?

Peripheral nerve blocks freeze or numb a single leg, arm or shoulder. The anesthesiologist injects the medication near the nerves that serve the surgical area. This medication freezes the area, so your child or teen doesn’t feel any pain. Patients can have a nerve block while awake, sedated or asleep.

When are peripheral nerve blocks most helpful?

Peripheral nerve blocks are commonly used for painful surgeries on the upper and lower body. This may include the hand, wrist, arm, shoulder, breast, foot, ankle, knee, leg and hip.

For procedures on the shoulder, arm, elbow or hand, your child or teen may have an injection at the side of the neck, below or above the collar bone, or in the armpit.

For procedures on the leg, knee or foot, your child or teen may have an injection in the groin, buttocks, thigh, or back/side of leg.

How long will the nerve block last?

The nerve block can be given as a single injection or by continuous infusion of numbing medication. A single injection is long acting. It will control pain for 6-18 hours after the surgery. The anesthesiologist uses Ultrasound to find the exact place to inject the numbing medication (see the picture below).

Picture of anesthesiologist using ultrasound to find the exact place to inject

For longer pain relief your child’s or teen’s anesthesiologist will insert a small tube (catheter) near the nerve (see the picture below).

Picture of anesthesiologist after peripheral nerve block catheter has been inserted and taped to the skin

The numbing medication is given continuously through this tube with a special infusion pump called ON-Q pump (see the picture below).

Picture of ON-Q pump
Image courtesy of Halyard Health. Used with permission.

This kind of nerve block controls pain for a few days after surgery. The ON-Q pump is a disposable pump and designed to give local anesthetic medication for 48 hours at home. The Anesthesiology team from CHEO will be contacting your child or teen every day while using this pump.

What happens when the nerve block wears off?

The feeling in the limb will come back. To prevent pain, give your child or teen oral pain medication before the nerve block begins to wear off completely. The Anesthesiologist will let you know how to switch from the peripheral nerve block to oral medications.

How can my child or teen get Regional Anesthesia?

The anesthesiologist will talk to you about regional anesthesia before surgery, if it will be helpful for your child or teen’s surgery. Your surgeon may also mention it to you and refer you to the Pre-Assessment Clinic (Anesthesia clinic) for a more detailed discussion with the anesthesiologist. If you think your child or teen would benefit from any type of block or you would like to have more information, feel free to ask your child’s or teen surgeon to refer you to Pre-Assessment Clinic.

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