Pain Control & Nerve Blocks

Pain after surgery is often one of areas our patients are most concerned with.  Your anesthesiologist will employ multiple strategies to attempt to minimize your discomfort after your procedure.  This may include- common medications, such as Tylenol or anti-inflammatory medications; regional anesthesia, such as a spinals, epidurals, or nerve blocks; or strong IV pain medications, such as morphine or a PCA (patient controlled analgesia) machine.

Nerve blocks – Also referred to as a ‘peripheral nerve block’, regional anesthesia is where a specific nerve or bundle of nerves to a specific area of the body can be made partially or fully numb.  This can be used as the sole form of anesthesia or combined with sedation or a general anesthetic.  This form of anesthesia is used to provide long-lasting pain relief during and after surgery.  It can last from 2 – 24 hours depending on the site and the drugs used.

How it is performed – The technique involves identifying the nerve(s) by ultrasound and/or electrical stimulation, then guiding a needle close to the nerve and injecting local anesthetic to around the nerve(s).

In some cases, a very fine tube/catheter is put through the needle and left in place in proximity to the nerve.  This means that the local anesthetic can be given for a longer period of time – at times up to a few days.

Location of nerve blocks – Your anesthesiologist will explain the particular block that is selected for your surgery, they are commonly used for surgery on the arms and legs but occasionally on the chest or abdomen.  There are many types of nerve blocks each aimed at different nerves.

 Potential Benefits of a Nerve Block

•  Better pain relief after your surgery

•  You may need less narcotic pain medication

•  Less narcotic related side effects (nausea, itching, constipation, and sedation)

•  Shorter recovery time

•  Extremely safe procedure

Potential Risk of a Nerve Block – Every anesthetic has risks of side effects and complications.  Most are temporary but some may cause long-term problems

Common Side Effects

•  Loss of muscle function for as long as the block lasts (this is normal)

•  Depending on the block site selected you may also experience one or more of the following: slight decreased breathing function or one pupil larger than the other

 More Common Potential Complications

•  Tenderness at injection site.

•  Non-functioning nerve block – this may require further injections and/or a change in anesthetic plan.

•  Bruising – please let your anesthesiologist know if you have recently taken any blood thinners such as: Aspirin, Warfarin, Lovenox, Plavix or Xarelto.

•  Infection (rare).

•  Nerve damage (rare).  Typically, nerve damage results in an area on your limb that remains numb to feeling while your muscle function returns.  When this occurs it is typically temporary and resolves within 2-6 weeks.  Permanent nerve damage is extremely rare, but a possibility.

•  Lung collapse (rare and only with some blocks).

Recovery From a Nerve Block – The area that has been blocked may remain numb or weak for up to 24 hours (longer if you have a tube inserted).  During this time you may not be able to tell if something is painful.  It is important that you do not place hot or very cold things on the affected part as these could cause burns.  If you have a ‘weak’ leg do not walk without assistance to avoid falls.