Know About Advantages And Disadvantages Of The Different Types Of Regional Anesthesia.

Some global trends in the health sector, such as the increase in ambulatory surgery, which allows the patient to go home on the same day as the intervention, affect the choice anesthesiologists make when providing regional anaesthesia. This and many other factors, such as those related to the patient and the type of intervention, influence the anesthesiologist’s decision.

Therefore, we analyse the advantages and disadvantages of the different types of regional anaesthesia. Plexus blocks, spinal anaesthesia (spinal and epidural), local injections or regional intravenous anaesthesia. What are the benefits and drawbacks of each type of regional anaesthesia for the patient, the healthcare provider and the health system?

SPINAL ANESTHESIA OR LUMBAR PUNCTURE

Spinal anaesthesia is a loco-regional technique in which an area or region of the body is blocked thanks to the administration of a local anaesthetic and other drugs in the nerve roots of the spinal cord before they leave the spinal column.

Small sizes (G 29 or G 27) are generally used for younger or thinner people and larger sizes (G 22) for people who are heavier and older. The most commonly used is the G 25 calibre because it covers a more significant number of patients.

Advantage

• Easier and faster technique than epidural anaesthesia since it is easier to access the central area.
• Immediate effect.
• High success rate.
• Sensitive lock and very efficient motor.
• High muscle relaxation is obtained.
• A low amount of drugs is required.

Disadvantages

• In general, it is not a technique to be repeated since it generates a headache due to the loss of cerebrospinal fluid. Therefore, on infrequent occasions, a catheter is placed, and this is used as a pain-reducing method only in elderly patients.
• In addition, there is a risk of infiltrating too high or too small a dose, and as we see above, it is not advisable to repeat the technique.
• It is not recommended for people with heart and hemodynamic problems due to the immediacy of the effect. The body does not have time to adapt.
• Risk of headaches and headaches due to loss of cerebrospinal fluid.
• The patient cannot leave the health centre if there is postoperative urinary retention (PUR), defined as the inability to urinate in the presence of a full bladder, which lengthens the hospital stay.

EPIDURAL ANESTHESIA 

Epidural anaesthesia is the introduction of local anaesthetic into the epidural space, thus blocking the nerve endings as they exit the spinal cord.

Advantage

• Allows placement of a catheter to:
• Extend the effect time of anaesthesia.
• Inject postoperative treatments.
• Analgesia without motor blockade but with a sensory and vegetative blockade, which is very useful in interventions such as childbirth.
• It can be executed at all spine levels, the most common at the lumbar level.
• It does not generate headaches as there is no loss of cerebrospinal fluid, as long as it is done correctly, causing more headaches than a spinal one if, by mistake, it passes from the epidural space to the spinal one.
• At the hemodynamic level, it is better tolerated since it takes effect after 25-30 minutes, and that gives the body more time to adapt.

Disadvantages

• As it takes longer to take effect, it cannot be used for emergency techniques such as a caesarean section.
• It implies a higher amount of drugs.
• The failure rate is 10%, which shows that it is a more complex technique than spinal anaesthesia.
• Less muscle relaxation than with spinal anaesthesia.
• It is not well adapted to outpatient surgery, which can cause urinary retention.

PLEXUS BLOCKADE

Peripheral plexus blocks are a type of regional anaesthesia that consists of injections directly into the area to be anaesthetised. They are used in surgeries of the lower or upper extremities.

In upper extremity surgeries, the alternative to this technique is general anaesthesia, local infiltrations, the increasingly unpopular regional intravenous anaesthesia or cervical epidural anaesthesia. Superior plexus blocks are widespread techniques in services such as anaesthesia, pain units or traumatology, requiring more significant knowledge of anatomy by the anesthesiologist.

On the other hand, inferior blocks can be used as alternatives such as local injections, general anaesthesia, spinal anaesthesia or epidural anaesthesia. These much more comfortable and effective alternatives in lower extremity surgeries mean that plexus blocks have lost popularity and are practically only used in the upper extremities, in many cases due to the lack of exhaustive anatomical knowledge on the part of the anesthesiologist.

The advantages and disadvantages of this technique compared to general anaesthesia are:

Advantage

• The patient recovers faster than from general anaesthesia.
• Rehabilitation can start earlier.
• This technique is increasingly performed with a neurostimulator and ultrasound, which gives the health worker greater security and a higher success rate.
• It is possible to maintain postoperative catheter analgesia.
• It is the ideal anaesthesia for outpatient surgery since the patient can leave the health centre after the intervention.
• It has few side effects: no urinary retention, and it cannot cause hemodynamic problems.

Disadvantages

• The technique is more limited to the lower or upper extremities.
• It is an uncomfortable technique for the patient.
• It is a complicated technique because it requires more excellent anatomical knowledge from the health worker.
• The amount of drug needed is more remarkable than general anaesthesia.

We live in an exciting time in which drugs and techniques constantly evolve to shape the range of options available to anesthesiologists. For this reason, the continuous training of these professionals is a “must” to offer patients the best possible experience.