Regional Anesthesia in Orthopedic Surgery

Regional anesthesia has a wide application in orthopedic surgery. It can be used as an adjunct pain relief therapy or as an analgesic during surgery. Providing many benefits to patients, including improved pain control and faster recovery times, regional anesthesia is now being incorporated regularly into many surgical treatment plans.

“Regional anesthesia techniques are very safe and have an extremely low complication rate,” says David Miller, M.D., Director of Anesthesia Services for Northern Westchester Hospital. “Using ultrasound guidance and a nerve stimulator, we are able to place nerve blocks that provide enhanced pain relief without the side effects associated with oral pain medication.”

Regional anesthesia can be beneficial in a variety of surgeries.

Knee Replacement

As more patients continue to undergo knee replacement surgeries at younger ages, protocols need to be in place to ensure that rehabilitation begins quickly after surgery, allowing patients to return to an active lifestyle as soon as possible. To accommodate this, a femoral nerve block can be placed prior to the procedure. This anesthetic is used as an adjunct therapy and is infused through a catheter prior to surgery, so patients experience enhanced pain relief post surgery. The catheter remains in place for 48 hours after surgery, and pain medication is continuously infused through the catheter during this time.

During the procedure, spinal anesthesia is used for primary pain control. Compared to general anesthesia, spinal anesthesia has several benefits, including less blood loss during surgery due to lower arterial and venous pressure, maintained blood circulation — which reduces the rates of deep vein thrombosis in the lower extremities — and reduced infection rates.

Shoulder Surgery

An interscalene block can be used for patients who are undergoing either ambulatory or inpatient shoulder surgery to provide postoperative analgesic. This block is also placed prior to surgery and is used as an adjunct along with primary surgical anesthesia.

Ambulatory and inpatient shoulder procedures are generally performed under light general anesthesia.

Foot Surgery

All foot surgeries performed at Northern Westchester Hospital are performed under either light general anesthesia or spinal anesthesia. To complement pain control achieved during surgery, a popliteal fossa block is used to provide postoperative relief.

Like both the femoral nerve block and interscalene block, the popliteal fossa block is placed preoperatively, so patients are comfortable when they awake after surgery and do not need additional pain relief. However, instead of having continuous dosage supplied through an indwelling catheter, pain relief is achieved through a single injection.

“Patient satisfaction is extremely high when utilizing regional anesthesia,” says Dr. Miller. “Patients are much more alert after surgery and have a much lower incidence of postoperative nausea.”

Other patient benefits include an earlier hospital discharge and an improved ability to tolerate physical therapy after surgery.

To learn more about orthopedic surgery services available at Northern Westchester Hospital, visit

MD News October 2010, Lower Hudson/Bronx