If you're planning surgery and have never had (or heard of) a nerve block, a type of regional anesthesia, you'll be surprised at how simple and effective it is.
The anesthetist inserts a fine needle into the surgical site and injects pain medication to bathe (but not touch) the nerves. Then, when the surgeon makes the incision, the nerves are too numb to do their normal job of alerting the brain to pain, meaning you won't feel it.
"Nerve blocks are a way to better manage acute pain at the time of surgery and can help us ease the transition to pain control at home," he says.Jinlei Li, MD, Yale Medicine's director of regional anesthesia for Yale New Haven Hospital's Saint Raphael campus. While nerve blocks have been around for decades, better ultrasound guidance in the 1990s increased the precision of injections, making them a safer and more effective option, says Dr. Li
Unlike general anesthesia, says Dr. Li, patients who use nerve blocks reap several benefits, including better pain control, less time in the hospital, faster recovery, and less need for medication when they go home. He works to make nerve blocks available to more Yale Medicine patients undergoing musculoskeletal and other surgeries and continues to research their effectiveness.
Are there different types of nerve blocks?
An anesthetist will choose a type of nerve block based on several factors, including your general health and the type of surgery you plan to undergo. In many cases, your doctor can give a single injection of a drug that relieves pain during surgery and often for a few hours afterwards.
Depending on the location of the surgery, there are also epidural blocks, which are often used to control pain during childbirth, and spinal blocks, in which numbing drugs are injected near the spinal canal. For some patients, the anesthetist may recommend using a combination of medications and techniques that provide nerve block,general anesthetic— and in some cases, a small amount of opioid medication — to provide the most effective relief in a given situation.
Can someone have a nerve block?
If you're going to have surgery, talk to your surgeon or anesthesiologist beforehand to ask if you're a candidate for a nerve block.
You may not be eligible for an injection site if you have an infection at the injection site, if you have a blood clotting disorder, if you are taking an anticoagulant (a medicine like warfarin that prevents blood clots) that you were not taking. stopped early or if you have had problems with the nerve in the area that would be the target of the injection.
How is a nerve block administered?
The anesthetist performs a nerve block before entering the operating room. You will often be given a mild sedative first to ease the anxiety and help you relax. He or she will then insert a hair-thin needle, about the size of an acupuncture needle, and inject medication into the surgical site in an area around the nerve. The anesthetist watches the progress of the needle on a monitor and uses "real-time" ultrasound guidance to ensure the pain-relieving medication is being administered accurately.
With a nerve block, the idea is to simply send medication around the nerve so the nerve can absorb it. It is important to avoid direct injection as it can cause serious side effects such as numbness or weakness in the extremities. The anesthesiologist can choose from a variety of numbing medications, including lidocaine, which is also used as an anesthetic for dental procedures.
A nerve block usually takes less than 10 minutes and up to 30 minutes to take effect.
How will the nerve block feel?
When your anesthetist gives you a mild sedative, you may feel sleepy and relaxed. The injection of the nerve block itself should cause minimal pain, if any. Otherwise, certain procedures, such as hand surgeries, require you to be able to remain awake and aware of your surroundings and to be able to communicate freely with your caregivers during the surgery if you wish. This differs from general anesthesia, which would render you unconscious and could cause persistent confusion and cognitive impairment upon waking, especially if you are an older adult.
After the surgery is complete, you may experience some heaviness or numbness due to the nerve blockage. It's important to talk to your doctor before getting up and moving or putting pressure on your body, as the nerve block may affect your muscle control and balance for a while.
How long does the nerve block last?
If you have a nerve block from a single injection, pain relief can last a few hours after surgery, and up to 24 hours in some cases.
How well the nerve block controls pain also depends on the type of surgery, e.g.Total knee replacement surgery can cause a lot of pain, bruising, and swelling during physical therapy and is more difficult to recover from than finger surgery, for example. If you're still in pain after the nerve block has cleared and are concerned about the pain when you go home, you can talk to your doctor about additional medications.
In most cases, your doctor will prescribe pain relievers in pill form that you can take at home. There are non-opioid options and talk to your doctor about your preferences.
What are the risks of nerve blocks?
As with anything else, there are risks, although rare, associated with nerve blocks. This may include bleeding, pain or infection at the injection site.
Nerve injuries are rare. When it happens, in most cases it is temporary and very rarely becomes permanent. In general, the rate of nerve injury is low and varies depending on the type of nerve block and surgery. As with any type of anesthesia or surgery, you should tell your anesthesiologist immediately if you experience any unusual sensation.
What Are the Benefits of Nerve Blocks?
Nerve blocks have been shown to be more effective at controlling pain than intravenous (IV) or intramuscular (IM) drugs, where drugs are injected into a vein or muscle. Because a nerve block controls acute pain so well, post-surgery patients tend to need fewer pain medications in the hospital and at home.
Another benefit of a nerve block is that for select procedures, you can avoid general anesthesia, which has side effects that can range from nausea and vomiting to temporary confusion.
Because you don't have to recover from a nerve block and usually have less pain later, you can start eating and drinking sooner and participate in physical therapy earlier after surgery, which is associated with faster healing and better health outcomes. You can go home from the hospital earlier and start physical therapy to fully heal.
Can nerve blocks help me limit opioid medication after surgery?
A nerve block is a strategy to limit the use of prescription opioids, which are a type of narcotic once thought to be the most effective treatment for pain. Opioids control pain by reducing the intensity of pain signals, which affect the areas of the brain that control sensation and emotion. If used incorrectly, they pose serious health risks.
Until relatively recently, opioid medications, such as the powerful narcotic oxycodone or its long-acting formulation sold under such well-known brand names as OxyContin, were routinely prescribed to help surgical patients manage pain upon returning home. Many people today want to avoid opioids because the drugs are highly addictive or because they have experienced unpleasant side effects such as constipation, confusion, drowsiness, sluggishness, and nausea.
Non-opioid alternatives include acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like Celebrex. Other drugs commonly used to control pain include gabapentin, also known as neurontin; pregabalin, also known as Lyrica; and ketamine. In some cases, the anesthesiologist will use these pain relievers in combination with opioid pain relievers, but with less opioid medication and for a shorter period of time.
Opioids can still be an important part of pain control for some people, including those who have active bleeding disorders or other contraindications to nerve blocks. If you have questions about opioids, talk to your doctor.
Why Should You Consider Talking to a Yale Medicine Physician About Nerve Block Surgery?
Yale Medicine AnaesthesiologySpecialists offer a wide range of medicines, devices and techniques that are not so easy to find in other medical centers. They offer many regional approaches to pain management and have extensive experience in their application.
Patients expecting surgery should know that Yale Medicine offers nerve blocks for the vast majority of musculoskeletal surgeries, as well as many other surgeries, and tailors its recommendations to each individual. "Our task is to provide each patient with precise and individual care," says Dr. Li
How long will the nerve block last? This depends on the type of block performed and the type of numbing medication used. For example, nerve blocks for hand surgery usually last for 6-8 hours, but a nerve block for pain after total knee replacement can last for 12-24 hours.What are the 4 types of nerve blocks? ›
Nerve blocks are typically categorized into four main categories. These four nerve block categories include: therapeutic, diagnostic, prognostic, and pre-emptive. Therapeutic nerve blocks are used to treat chronic pain and various pain conditions.What is the nerve block in surgery called? ›
They are often injections of medicines that block pain from specific nerves. They can be used for pain relief as well as total loss of feeling if needed for surgery. Perhaps the best-known nerve block is an epidural.What is a permanent nerve block? ›
Surgical nerve blocks are permanent. They work by damaging or destroying specific nerve cells. Doctors may use them to treat chronic debilitating pain syndromes.How painful is a nerve block? ›
The nerve block injection itself should cause minimal pain, if any. Otherwise, for certain procedures such as hand surgery, you should be able to remain awake and aware of your surroundings and free to communicate with your caregivers during surgery, if desired.How painful is it when a nerve block wears off? ›
The orthopedic surgeon frequently encounters patients who complain of severe pain as the block wears off. The patients describe a sensation similar to the affected limb “falling asleep and then waking up”. More descriptive terms include: numbness, tingling, burning, stabbing and severe discomfort.What are the risks of nerve blocks? ›
While nerve blocks are relatively safe, they do have risks of side effects and complications. Some of these side effects include elevated blood sugar, rash, itching, weight gain, extra energy, soreness at the injection site, bleeding, and death in very rare cases.What are the cons of nerve block? ›
- Injury to the nerve.
- Muscle weakness.
- Increase in pain.
- Spinal headache.
To perform a nerve block, we inject anesthetic, anti-inflammatory, or a combination of medications into your affected nerve to treat irritation, inflammation, and pain. Once in place, these medications get to work immediately, “turning off” the receptors that trigger your pain.What kind of sedation is used for nerve block? ›
ASA - IV sedation for therapeutic nerve blocks | Choosing Wisely.
Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia.Are nerve blocks done under anesthesia? ›
A nerve block is the injection of local anesthetic close to a targeted nerve or group of nerves to lessen pain. This is particularly useful in determining the source of the pain. Injection of anti-inflammatory medication in conjunction with local anesthetic may promote healing of damaged nerves.How many times can you have a nerve block? ›
Depending on your orthopedic physician's recommendation, you may receive nerve block injections anywhere between three to six times in a 12-month period. The sooner you start receiving nerve blocks, the better its chance of success, especially when combined with other treatment methods such as physical therapy.Is gabapentin a nerve blocker? ›
Yes, gabapentin is used for treating epilepsy by 'calming down nerves'. Research has shown that gabapentin by a 'similar process' is also effective in helping to relieve certain types of pain.How much does a nerve block injection cost? ›
How Much Does a Peripheral Nerve Block Cost? On MDsave, the cost of a Peripheral Nerve Block ranges from $252 to $4325. Those on high deductible health plans or without insurance can shop, compare prices and save.Will I be able to walk after a nerve block? ›
Cut down on your usual activities, including work, for 24 to 48 hours (1 to 2 days) after your nerve block unless told otherwise by your nurse or pain doctor. You can go back to your usual activities in about 1 to 3 days. Use crutches or a brace when walking, if you have been told to use them.Can you go home with a nerve block? ›
Doctors use nerve blocks to help patients feel better faster, recover more quickly and go home sooner. It used to be that patients were hospitalized for as long as 5 to 6 days following major joint surgery such as a hip or an artificial knee.Does a nerve block paralyze you? ›
A nerve block may cause temporary muscle paralysis or a loss of all feeling in the affected area or in the surrounding area. Nerve blocks can be used to determine the source of pain, to treat painful conditions, and to predict how pain will respond to long-term treatments.What happens if a nerve block doesn't wear off? ›
There is a risk a temporary nerve block may cause permanent nerve damage. If that happens, the patient may experience side effects like weakness, numbness that never subsides or muscle paralysis. Surgical nerve blocks are often designed to either destroy a damaged peripheral nerve or nerve roots.Can a nerve block last 2 weeks? ›
After we inject your nerve block, you rest for 15-30 minutes while the medication takes effect, but you can expect to start noticing pain relief immediately. These results are only temporary, however, and typically last for 1-2 weeks.
Nerve damage after peripheral nerve block is usually temporary and most patients make a full recovery within a few days or weeks. 1,2 However, rarely, nerve damage is permanent.What are the side effects of nerve block injection? ›
While nerve blocks are relatively safe, they do have risks of side effects and complications. Some of these side effects include elevated blood sugar, rash, itching, weight gain, extra energy, soreness at the injection site, bleeding, and death in very rare cases.Is it normal for a nerve block to last longer than 24 hours? ›
For example, nerve blocks for hand surgery usually last for 6-8 hours, but a nerve block for pain after total knee replacement can last for 12-24 hours. Medication continuously delivered through a tiny plastic tube (nerve catheter) placed next to the nerve can last for 2-3 days.Are there any restrictions after a nerve block? ›
Please arrange to have someone drive you home after the nerve block, as you will not be able to drive or operate machinery for at least 24 hours after the procedure. You must be healthy on the day of your nerve block. You must: Be free of infection and not taking antibiotics.How long should you rest after a nerve block? ›
Cut down on your usual activities, including work, for 24 to 48 hours (1 to 2 days) after your nerve block unless told otherwise by your nurse or pain doctor. You can go back to your usual activities in about 1 to 3 days.What to expect after a nerve block wears off? ›
The numbing medicine will begin to wear off about 6 to 24 hours after the nerve block. You will notice a change in the way your limb feels – it may begin to feel less numb, less weak, and you may feel a tingly sensation as if it's “asleep.” It may take 1-4 hours for the nerve block to completely wear off.Can a nerve block cause paralysis? ›
A nerve block may cause temporary muscle paralysis or a loss of all feeling in the affected area or in the surrounding area. Nerve blocks can be used to determine the source of pain, to treat painful conditions, and to predict how pain will respond to long-term treatments.What is the success rate of nerve blocks? ›
The study showed that for patients who had pain relief after two prognostic blocks on two different days, the nerve ablation was successful in 64%.What are the complications of surgical nerve block? ›
Risks include block failure, bleeding, infection, damage to surrounding structures, permanent nerve injury, and intravascular uptake of local anesthetic resulting in systemic toxicity.What medication is used in a nerve block? ›
The use of adjuvant drugs for single-shot peripheral nerve blocks (sPNB), such as alpha-2 agonist, dexamethasone, midazolam, and non-steroidal anti-inflammatory drugs (NSAIDs), extends the duration of local anesthetics and reduces the dose-dependent adverse effects of local anesthetics (9).