surgical nerve blocks (2023)

general description

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