Regional anaesthesia has its origins in 1884, 38 years after the discovery of general anaesthesia, when Carl Koller instilled a solution of cocaine into a patient's eye and performed glaucoma surgery ‘under local’. This landmark discovery led to an explosion of interest in blocking nerve conduction as surgeons looked for less dangerous alternatives to the general anaesthetic techniques then available.

General principles of management

Several important factors, common to all major regional anaesthesia techniques, require consideration to minimise risks and promote high standards of patient care.

Patient preparation

Preoperative preparation of the patient for regional anaesthesia should fulfil the same standards of care as for general anaesthesia because regional anaesthesia should not be regarded as a shortcut for high-risk patients. A full explanation of the intended block should cover the conduct of the injection, patient management during surgery and recovery from the effects of the block. The advantages to patient, surgeon and anaesthetist may be discussed. The more common side effects that may be experienced should be outlined and the patient offered the choice of whether to remain fully conscious during surgery, have a sedative premedication or intravenous sedation during the procedure. Major complications of regional anaesthesia are rare (less than 1%). Contraindications to regional anaesthesia are also relatively uncommon, and are shown in Figure RA1.

Performing the block

Major regional anaesthetic techniques require formal sterile procedures, especially central nerve blocks, where meningitis and epidural abscess are rare but definite risks.