Patients who are scheduled to undergo surgeries on their extremities (shoulders, elbows, hands, feet, ankles, knees) often have the opportunity to have regional anesthesia. This can be a neuraxial block (spinal or epidural), or a peripheral nerve block (anesthesia injected around specific nerves).

The advantages of having regional anesthesia include less risk for having postoperative nausea and vomiting, smaller blood loss and the avoidance of the after-effects of general anesthesia. For people having peripheral nerve blocks there is the added advantage that the pain relief lasts well into the postoperative period, and patients can often go directly home right from the operating room.

Specifically, spinal and epidural anesthesia is for surgeries of the hips and knees, ankles or feet. The patient is usually given a light sedative medication. His/her back is washed with sterile solution and local anesthesia is given with an extremely small needle, to numb the area. Then a needle specific for the type of anesthesia (either spinal or epidural) is used to locate the appropriate space for the local anesthesia and a dose, calculated to last the duration of the surgery, is administered. If an epidural is chosen, a catheter (small plastic tube that one can lay on) is inserted. This is so that more local anesthesia can be given if the surgery takes a long time, or so other medicines can be given to provide pain relief in the postoperative period. THE PATIENT WILL NOT NECESSARILY BE AWAKE THROUGH SURGERY. Once the spinal/epidural has been placed, the anesthesiologist can give the patient sedative medications so that he or she will not be aware of what is going on, if that is what the patient prefers.

Peripheral nerve blocks use technology to find the location of the nerves that give rise to the sensation over parts of the body. Nerves can be located using small amounts of electric current that flow through a needle (which makes muscles "jump," but does not cause any pain) or by looking directly at them with an ultrasound machine (which uses sound waves transmitted through the skin). Once the appropriate nerves are identified, local anesthesia is injected to bathe them, which will provide pain relief for the surgery. Again, the anesthesiologist will give the patient sedative medications to ensure that he or she is relaxed during the procedure.