Other Types of Anaesthesia

• Types of Anaesthesia


  • General anaesthesia
  • Peripheral Nerve Blocks
  • Central Neuraxial Anaesthesia
• General anaesthesia has several side effects and risks
• It is desirable to keep the patient awake and only anaesthetise the area required for the operation when possible
• Keeping the patient awake and only anaesthetising the required area generally leads to better pain relief, fewer medication side effects, and a smoother recovery
• Peripheral Nerve Blocks


  • The patient remains awake during the procedure
  • A local anaesthetic is injected around specific nerves, causing the area distal to the nerves to be anaesthetised
  • A screen is put up between the patient and the operating site so that they cannot see the operation taking place
  • The injection is performed under ultrasound guidance, sometimes with the help of a nerve stimulator
  • Regional anaesthesia will be performed where there are facilities available to quickly induce a general anaesthetic if it is not effective or the patient starts to experience pain
  • Patients are closely monitored
  • Sedation may be given to help the patient relax
  • Sometimes a patient may have a combination of regional and general anaesthesia to reduce the physiological response during surgery and improve pain management post-operatively
• Central Neuraxial Anaesthesia


  • Also known as a spinal anaesthetic or spinal block
  • The patient remains awake during the procedure
  • A local anaesthetic is injected into the cerebrospinal fluid, within the subarachnoid space
  • It is only used in the lumbar spine, after the point where the spinal cord ends, to avoid damaging the spinal cord
• Neuraxial anaesthesia


  1. Numbness and paralysis of the areas innervated by the spinal nerves below the level of the injection

  2. Cold spray applied to the skin to test if the anaesthetic has worked

  3. Takes around 1-3 hours for the anaesthetic to wear off
• Epidural Anaesthesia


  1. Most commonly used for analgesia in pregnant women in labour and post-operatively after a laparotomy

  2. Involves inserting a small tube (catheter) into the epidural space in the lower back

  3. Local anaesthetic medications are infused through the catheter into the epidural space, diffusing to the surrounding tissues and spinal nerve roots for an analgesic effect
• Common examples of procedures using local anaesthesia

  • Skin sutures in A&E after a skin laceration
  • Minor surgery to remove skin lesions
  • Dental procedures
  • Hand surgery (e.g., carpal tunnel syndrome surgery)
  • Performing a lumbar puncture
  • Inserting a central line
  • Percutaneous procedures (e.g., percutaneous coronary intervention)
• Local anaesthesia is used to numb a very specific area where a procedure is being performed
• Adverse effects of epidural anaesthesia

  • Headache if the dura is punctured ("dural tap")
  • Hypotension
  • Motor weakness in the legs
  • Nerve damage (rare)
  • Infection, including meningitis
  • Haematoma (may cause spinal cord compression)
• When used for analgesia in labour, risks include prolonged second stage and increased probability of instrumental delivery
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