Central regional anaesthesia

Central regional anaesthesia, also called neuraxial block, refers to either epidural or subarachnoid anaesthesia, forms of regional anaesthesia. Both types may cause haemodynamic changes, especially hypotension, due to blockade of the sympathetic fibres.

Indications

Regional anaesthesia is preferable (compared to general anaesthesia) in:

• Surgical oncology
• Orthopaedic/traumatological surgery
• C-section
• Lower limb revascularisation
• Obese patients
• Elderly patients (prevents post-operative cognitive dysfunction (POCD)
• Paediatric surgery (in addition to general anaesthesia)

Epidural anaesthesia

Epidural anaesthesia involves injection of local anaesthetic with or without opioids into the epidural space to act on spinal nerve roots. Nerve roots around the site of injection are affected, while leaving the nerve roots above and below mostly unaffected. Epidural anaesthesia may be administered at any vertebral level. The drugs are administered via a catheter for continuous infusion.

Epidural anaesthesia is often used for surgeries in the lower body, like C-section, hernia repair, knee surgery, or during labour. It may also be used for postoperative or chronic pain management with an epidural catheter.

Spinal anaesthesia

Spinal anaesthesia, also called subarachnoid anaesthesia, involves injection of local anaesthetic with or without opioid into the subarachnoid space to act on the spinal cord. Unlike epidural anaesthesia, all motor and sensory function below the level of injection is blocked. Spinal anaesthesia is usually administered as a single injection.

Spinal anaesthesia may only be placed in the lumbar region. It has more rapid onset than epidural, but also causes more rapid haemodynamic changes than epidural. Like epidural anaesthesia, it is often used for surgeries of the lower body, below the level of the umbilicus.

Epidural and spinal anaesthesia may be combined, called combined spinal-epidural anaesthesia (CSE).