Do You Always Need General Anesthesia for Surgery? A Guide to the Different Types of Anesthesia

Most surgeries or medical procedures involve some type of anesthesia. And there is a wide range of medications that can help reduce any pain or discomfort during a procedure. Anesthesia has actually been around for centuries. Before, anesthesia medications included ether, opium, and cocaine. But the practice of anesthesia (anesthesiology) has come a long way since then. 

There are now different types of anesthesia that can be tailored to each person and situation. Here are the four main types of anesthesia, when they are used, and what their common side effects are.

What is local anesthesia?

Local anesthesia is when a medication — often lidocaine — is injected into your skin. It causes numbness in and around the injection area. So you don’t feel any pain from the procedure. This type of anesthesia works well when your procedure involves a small area of the body. And it has a number of benefits:

• It is given quicker than other types of anesthesia.

• It doesn’t require an anesthesia provider.

• You’re awake and can hear and see what’s going on around you.

• There’s minimal recovery afterward.

• There are fewer side effects, given the medication is only applied to one small area.

But many procedures can’t be performed with only local anesthesia. This will be covered in more detail in the other sections.

When is local anesthesia commonly used?

Local anesthesia is used for minor procedures, like: 

• Skin biopsies

• Breast biopsies

• Dental procedures

• Stitching up a wound

Side effects of local anesthesia

Local anesthesia is probably the safest form of anesthesia. There are very minimal side effects. The most common one is soreness at the site of injection. But in rare cases, people can have an allergic reaction to the medication. 

Another rare complication can happen if too much local anesthesia medicine is injected in your body. This can lead to:

• Confusion

• Slowed heartbeat

• Trouble breathing

• Seizures

But the chances of toxicity from too much local anesthetic are very low. They are estimated to occur every 3 in a 100 cases.

What is regional anesthesia?

Regional anesthesia uses medications like those used in local anesthesia — lidocaine, bupivacaine, and ropivacaine. The difference is that regional anesthesia numbs a larger area or region of the body. 

To do this, regional anesthesia targets bigger nerves that feed an entire area in the body — like the knee or shoulder. When the medication is injected around those nerves, it helps spread numbness in that part of the body. 

Depending on the specific medication used, the numbness can last anywhere from 4 hours to several days. This allows you to feel less pain both during and after the surgery. 

Regional anesthesia has a subset (neuraxial anesthesia) that includes spinals and epidurals. Local anesthetic medications are injected near the spinal cord. This is so the body goes completely numb from the waist down. Depending on where the medicine is injected, you may temporarily lose feeling in your legs. 

When is regional anesthesia commonly used?

Regional anesthesia can be used in all kinds of surgeries and procedures — especially those on the arms and legs. Before you’re given anesthesia, the specific nerves are chosen based on where you are getting surgery. Some examples of regional anesthesia include:

• Epidurals during labor: They help with the pains of labor contractions and help you stay awake and push the baby out.

• Spinals for C-sections and joint replacements: Spinal anesthesia causes total numbness of the belly and legs. This is so you don’t feel any pain during the surgery.

• Nerve blocks on the neck: These can be used for hand and shoulder surgery.

• Nerve blocks on the leg: These can be used for knee and ankle surgeries.

Side effects of regional anesthesia

Regional anesthesia is a very safe form of anesthesia. The side effects are similar to those with local anesthesia. You can have some soreness in the area of injection. There’s also a very rare chance of toxicity if you receive too much. Other side effects include: 

• Infection at the site of injection

• Bleeding if a blood vessel is injured during injection

• Numbness in a larger area than was intended (this goes away as the medication wears off)

• Nerve injury that causes prolonged numbness of the area (this also usually goes away with time depending on the dosage)

• Headache 

• Low blood pressure, which can cause some nausea

• Injury to other body parts surrounding the site of injection 

Overall, regional anesthesia is considered safer than general anesthesia. It’s preferred for surgeries like knee replacements. 

What is procedural sedation?

Sedation is a type of anesthesia that uses IV (intravenous) medications to ease pain, anxiety, or both. This includes:

• Midazolam (a benzodiazepine) 

• Opioid pain medications

• Propofol

• Ketamine

There are different levels of sedation depending on the procedure and how you would respond to the medications. These include:

• Conscious sedation: This is the lightest level of sedation. And it does not need an anesthesia provider. You will feel relaxed and sleepy but stay awake. 

• Twilight anesthesia: This is slightly deeper sedation and needs a provider trained in anesthesia. Most people are awake enough to interact with the healthcare team during the procedure, but they often do not remember any of it. 

• Deep sedation: This is the deepest level of sedation — someone is sleepy enough to take a nice nap. This often requires close monitoring and some oxygen since the sedating medications can cause you to breathe slower or shallower.

When is sedation commonly used?

Sedation can be used in a variety of procedures and settings, including:

• Colonoscopies

• Biopsies

• Minor surgeries

• Together with regional anesthesia for optimum pain control and relaxation

• Gynecological procedures like endometrial biopsies and LEEP procedures

• Fracture and dislocation reductions and splintings

• Cardiac catheterization

Side effects of sedation

Sedation with a licensed anesthesia provider is typically safe. Some expected side effects of the medications include:

• Drowsiness

• Slower breathing

• Low blood pressure

• Allergic reactions

• Nausea and vomiting 

• Confusion

Compared to general anesthesia, recovery from sedation is often quicker. It usually takes less than an hour for the medications to wear off after the procedure. 

What is general anesthesia?

General anesthesia is probably what comes to mind when thinking of surgery. It is the deepest form of anesthesia and means you are fully unconscious. General anesthesia uses IV and inhaled medications to keep you asleep and prevent you from feeling pain from the procedure. These include many of the same medications listed above for sedation, just in higher doses. 

Since you’re fully asleep, you often need a breathing tube and a ventilator to breathe for you while the medications are in your system. The breathing tube can usually be removed right after the procedure as the medications wear off. 

When is general anesthesia commonly used?

Most major surgeries — ones that involve the heart, abdominal organs, or brain — need general anesthesia. It can also be used for more minor procedures where you need to stay very still — like some minimally invasive cardiology procedures.

Side effects of general anesthesia

Unlike other types of anesthesia, the medications and doses used during general anesthesia have more side effects. These include:

• Nausea and vomiting

• Low blood pressure

• Changes in heart rate

• Slower breathing 

• Sore throat from the breathing tube

• Grogginess from all the medications and anesthesia

• Delirium (confusion) after the procedure 

Some of these side effects — like blood pressure and heart rate — can be easily treated with fluids and medications. And other changes — like your breathing rate — might need medical equipment like a ventilator. A healthcare provider will monitor you closely for a few hours after general anesthesia. They help make sure your vital signs and mental state return to normal. 

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Written by:

Nicole Andonian, MD

Nicole Andonian, MD, is a private practice anesthesiologist in Orange County, California. Her focus is in general anesthesia, regional anesthesia, and acute pain management.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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