What are Nerve Blocks?
Nerve blocks are a way to help reduce pain and discomfort after surgery. Nerve blocks are performed by injecting numbing medication around the nerves (or in the plane where the nerves are) that carry painful sensation from the surgical area (for example, arm/leg/belly/chest). In almost all pediatric patients, nerve blocks are used together with general anesthesia for surgical procedures.
Depending on the age of the patient, nerve blocks can be done while the patient is still awake or, more commonly, after the patient is asleep under general anesthesia.
The exact place where numbing medication is injected depends on where the surgical procedure is done. For procedures on the shoulder, arm, elbow or hand, injections may be made at the side of the neck, below or above the collar bone, or in the armpit. For procedures on the leg, knee or foot, injections may be made in the groin, the buttocks, the thigh, or the back or side of the leg. For procedures on the belly/chest, injections may be made on the front or the side of the belly/chest or the back.
The anesthesiologist will discuss with you which nerve block will work best for your child and its benefits and risks.
What is the Purpose of a Nerve Block?
Nerve blocks can provide significant pain relief after surgery. They often substantially reduce the need for pain medications and reduce their related adverse effects, like vomiting, drowsiness and slow breathing. A nerve block may help your child sit up in a chair or walk around after surgery without being very uncomfortable.
One-time injection (single shot) nerve blocks typically provide pain relief for 8-24 hours. Continuous nerve blocks with nerve catheters for major painful surgeries can provide pain relief for typically two to three days, or as long as the nerve catheter is being used.
What are Possible Complications with Nerve Blocks?
In general, complications are very rare. However, possible complications include:
- less-than-perfect pain relief
- bruises
- discomfort where the needle was inserted
- prolonged "pins-and-needles" sensation after the block wears off
Any type of long-lasting or permanent damage to nerves is very rare. Your anesthesiologist will discuss any potential problems and risks with you in detail.
What to Expect After a Nerve Block
The area of the body covered by the nerve block may be numb, meaning that no or only a little pain will be felt. So it is important to watch that nothing harms that area while it is still numb because no pain will be felt. Keep it away from heaters, fires, car doors and sharp objects.
When the numbness wears off, the pain or discomfort will increase. The amount of pain will vary depending on the operation.
The best way to keep your child comfortable is to give them the medication that has been prescribed as soon as the pain begins. It is better to treat pain in advance than to catch up with it.
For certain operations, taking ibuprofen as soon as possible—even before the nerve block wears off—can decrease pain. This should be discussed with your child's doctor at the time of surgery.
If Nerve Block Lasts Longer Than a Day
It is possible that some nerve blocks may last longer than a day. But if your child cannot move the arm/leg or feel any sensation at all (touch, warm, cold, pain) for more than 24 hours after a nerve block was placed, contact your child’s doctor.
Continuous Nerve Catheters
For major and painful surgeries such as knee reconstruction, shoulder surgeries and pectus surgeries, often a continuous nerve catheter (thin plastic tube) placement is needed to provide longer pain relief for typically two to three days.
Nerve catheters are placed by anesthesiologists in the operating room while children are under anesthesia and continuous infusion of numbing medication.
Sometimes, children are discharged home with nerve catheters and a numbing medication infusion pump to provide pain control at home for two to three days. Acute Pain Service will actively manage children with nerve catheters. Remote pain monitoring services may also help manage the nerve catheters.
