What are Nerve Blocks?
Nerve blocks are a way to help reduce pain and discomfort after surgery. Nerve blocks are done by injecting numbing medication around the nerves that carry painful sensation from the part of the body where the surgery is done. In almost all pediatric patients, nerve blocks are used together with general anesthesia for surgeries.
Depending on the age of the child, nerve blocks can be done while they are still awake or, more commonly, after they are asleep under general anesthesia.
The place where numbing medication is injected depends on where the surgery is done. For surgeries 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 surgeries 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 surgeries on the belly or chest, injections may be made on the front or the side of the belly or chest or on the back.
The anesthesiologist, a doctor who gives numbing medicine, will talk with you about 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 give significant pain relief after surgery. They often reduce the need for pain medications. They can also reduce the negative effects of pain medicine, like vomiting, sleepiness, 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 give pain relief for 8-24 hours. Continuous nerve blocks with nerve catheters (thin plastic tube) for major surgeries are usually used to give pain relief for two to three days, or as long as the nerve catheter is being used.
What are Possible Problems with Nerve Blocks?
In general, problems are very rare. But possible problems 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. This means that no or only a little pain will be felt. 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. This usually happens 6-12 hours after the nerve block is done. The anesthesiologist may use more medications within the local anesthetic to make the nerve block last longer. These added medications can make the numbness last for up to 48 hours. The amount of pain the patient has once the numbness is gone will vary depending on the surgery.
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 as it starts than to catch up with it.
For some surgeries, taking ibuprofen as soon as possible—even before the nerve block wears off—can decrease pain. Talk with your child's doctor about this 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 their arm or leg or cannot 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 like knee reconstruction, shoulder surgeries and pectus surgeries, a continuous nerve catheter (thin plastic tube) placement is often needed to give longer pain relief—usually for two to three days.
Nerve catheters are placed by anesthesiologists in the operating room while children are under anesthesia.
Sometimes, children are sent home with nerve catheters and a numbing medication infusion pump for pain control at home for two to three days. The Acute Pain Service team will actively manage children with nerve catheters. Remote pain monitoring services may also help manage the nerve catheters.
