Anesthesiologist Questions Anesthesia

Is there a difference between local and regional anesthesia?

I've heard anesthesiologists throw both of these terms around, and I can't imagine them having much of a different meaning. Is there a difference between these types of anesthesia?

8 Answers

The answer actually depends on what is meant by the question. The pharmacologic agents (i.e. drugs) used to create numbness in a part of the body are generally classified as "local" or "regional" anesthetic agents. Whether they act as local or regional anesthetics however depends on the manner in which they are administered. Anesthesiologists can take a bottle of one of these agents, and inject it rather superficially in the skin, and create a "local" anesthetic", which would numb the skin, and maybe a bit of an area around where it was injected. This would be a true"local anesthetic". On the other hand, the same drug could be administered deeper around the nerves going to a part of the body, and create numbness in an entire region, such as an entire arm or hand, or foot, or leg. In this case, it would be considered a true regional anesthetic, or "regional block", as the numbness would be accomplished in a region of the body, instead of just in a highly localized area.
Local anesthesia refers to using a local anesthetic like lidocaine or bupivacaine to inject around a structure to be cut which makes the area numb. Regional anesthesia involves injecting the same local anesthetic around a nerve or group of nerves to numb a large area that the nerve(s) supplies such as a interscalene brachial plexus block to numb a shoulder.
Local anesthesia is a generic terminology referring to numbing of the area. This can be accomplished by injecting/instilling the drug around specific nerves i.e. numbing of the jaw by injecting around the nerve that supplies the sensations to the jaw or spinal/epidural analgesia for blocking lower body sensations. Instead of a patch of skin, numb the region supplied by the big nerves. The drugs used to accomplish this are called local anesthetics.
Depends on the context.

"Local" = "local anesthetics", like lidocaine, bupivacaine, etc. These medications block nerve conduction, and therefore block sensation, pain, and motor function

If a surgery is scheduled as a "local", in general that means the surgeon/proceduralist is injecting the local anesthetic. No anesthesia personnel are involved in the procedure, so there is no additional sedation. Examples of procedures commonly performed under local alone are dental procedures, temporal artery biopsies, some toe and finger procedures, etc

If a surgery is scheduled as a "peripheral nerve block," then the anesthesiologist injects local anesthetics around specific nerves that cover the region in which an operation is taking place. They do this before surgery. Anesthesiologists are involved the entire procedure, and most commonly give IV sedation as well to make the patients more comfortable. Examples of surgeries commonly performed this way are hand and arm surgery, foot surgery, sometimes shoulder surgery, etc.

However to confuse things, anesthesiologists also commonly refer to "local anesthetics" as just "local". So they may tell a patient "I will inject local." Also, surgeons may tell patients they are "just having local", when they are really referring to the patient receiving care from an anesthesiologist, and just not needing a general anesthetic.

So the terminology depends on the context and the caregiver.
Yes and no. Local means utrilizing local anesthetic like lidocaine in a specific location like a finger or toe. Regional means utilizing local anesthetic to block a region like arm, leg or below the waist
Today with more nerve blocks being performed, I believe many are using the terms interchangeably. The term regional denotes a specific area as opposed to a general anesthetic which is a state of unconsciousness that is generalized to the entire being. When I was in training the lines were not as blurred. Back then, we typically referred to spinal and epidural anesthetics as regional anesthetics. A lot of nerve blocks were not being done in my training which I finished 25 years ago. However, one thing that is for sure, all regional anesthetics as well as "locals", require the use of a local anesthetic. Today if the surgeon schedules a case as "local with sedation" for example, the surgeon plans to inject the local anesthetic in the area of surgery, while we provide sedation so that the surgeon can inject the local anesthetic with minimal discomfort to the patient. The injection of local anesthetic can be quite uncomfortable for many patients so the provision of sedation makes it less traumatizing to the patient. Thus, today regional techniques refer to the old spinal and epidural anesthetics, plus a variety of nerve blocks. Most local anesthetics are limited to small and area-specific site surgeries. Further, local anesthetic injections in a specific site are limited as to what type of surgery can be performed. No amount of local anesthetic injected by a surgeon into a shoulder could allow a surgeon to operate on a shoulder but a single interscalene nerve block can certainly allow a surgeon to perform shoulder surgery very effectively. I hope I have not muddied the waters.
Yes, there is difference between local and regional anesthesia, however, it can come confusing. Local anesthesia is typically adding anesthesia to a small area. An example may be if you had a laceration to your scalp requiring stitches, we would often use Lidocaine to numb the area with the laceration so it could be repaired with stitches. In regional anesthesia, as the word implies, we are blocking a region in the distribution of path of the nerve, so a larger area. A good example of this may be if you had medical reasons where doing general anesthesia should be avoided, and say perhaps a fractured wrist. The doctor wants to reduce the fracture and place an initial cast. We could do a regional anesthesia that would block the sensation going to the wrist/hand by blocking the nerve/branches. Thus a small amount of anesthetic can be used and kept in the area by slowing down blood flow, and the reduction of the fracture can be done painlessly without the risk or bother of general anesthesia. There are other examples, but I hope this explains the difference.
In local anesthesia, a local anesthetic is injected into the skin to allow pain-free surgery and is used for small skin lesions or dental work. Regional anesthesia implies placing local anesthesia near nerves to numb an entire extremity and is used for more extensive surgery.