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The Geography of Anesthesia: Local, Regional, or General

There are three types of anesthesia used for surgery. Local anesthesia numbs a small area, patch of skin, or body part. Regional anesthesia locks feeling in just one area, such as the shoulder or one side of the hip. General anesthesia puts the person to sleep, unaware of what's happening.

Certain operations have always required general anesthesia and an overnight stay in the hospital to control pain. Improvements in surgical technique have allowed more of these surgeries to be done under regional anesthesia. The person goes home the same day, unless severe pain requires further hospitalization.

Doctors want and need to know which anesthesia is best. They measure this by how long the patient stays in the recovery room, how much pain medication is used, and how long it is before the patient goes home. Complications such as blood loss or accidental injection of anesthesia into the lung, blood vessel, or spine are also considered.

One surgeon reviewed his own records to compare the results of shoulder surgery using regional versus general anesthesia. There were no differences in the amount of time patients stayed in the hospital. There were no differences in how long patients were in surgery or under anesthesia. The main difference was in how much pain patients had after surgery. Less pain was reported in the group that received regional anesthesia. This also meant less pain medication was used in the first four hours after surgery.

Health care providers are always looking for ways to reduce the costs of surgery. Avoiding an overnight stay in the hospital is one way to do this. Less time in surgery, less blood loss, less pain medication, and a shorter recovery time are also ways to decrease medical costs. Regional anesthesia is now being used with success for total hip replacement, shoulder repair, hysterectomy, and removal of the prostate.

References: Christopher L. Wu, MD, et al. Comparison of Postoperative Pain in Patients Receiving Interscalene Block or General Anesthesia For Shoulder Surgery. In Orthopedics. January 2002. Vol. 25. No. 1. Pp. 45-48.

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