FAQs on Peripheral Nerve Block

 

The peripheral nerve block is used to provide anesthesia to patients undergoing certain surgeries, and it is often used to treat pain of an extremity. This procedure can be done in the outpatient setting, and is considered a safe and effective option for pain management.

How does the peripheral nerve block work?

The peripheral nerve block works by injecting an anesthetic near a nerve or nerve bundle, which control(s) sensation and movement of an extremity. The block can also be used for surgeries around the neck or groin region.

What are the benefits of using a peripheral nerve block?

The peripheral nerve block is an alternative to general anesthesia and central nerve blocks. For some patients with serious medical issues, the peripheral nerve block is a safe choice for analgesia. The block restricts pain in one extremity, and offers long-term pain control. The peripheral nerve block reduces opioid medication use, and has few side effects and complications.

What medications are used during the procedure?

No single medication is recommended. However, most peripheral nerve blocks are done using bupivacaine or lidocaine. For longer duration of pain relief, a corticosteroid may be added.

How do I prepare for the peripheral nerve block procedure?

When you visit the pain management specialist, he will ask you questions about your condition, take a medication and medical history, and conduct a thorough exam. If the doctor decides the block will work for you, he reviews the procedure risks and benefits, and has you sign a paper of informed consent. Because a sedative is used, do not eat/drink after midnight the night before your procedure, and arrange to have transportation home.

How is the peripheral nerve block done?

After the nurse had you change into a procedure gown, an IV line is placed in your hand. Monitoring devices are used to check blood pressure, heart rate, and oxygen level. You are positioned on your back on the table, and a sedative is given. After the thigh/groin region is cleaned with an antiseptic. The procedure needle is guided into the skin, which is verified using real-time x-ray. A catheter can be left in for a continuous block/infusion, should more medication be needed, or if the patient is to remain in the hospital.  If a simple block is done, the medication is injected onto the nerve, the needle is withdrawn, and a bandage is applied.

What can I expect after the peripheral nerve block?

The incidence of complications is rare. However, around 1% of patients report some tingling sensations to the extremity that was blocked. When you awake from sedation, expect to be groggy and a bit dizzy. The nurse monitors your condition for around an hour before you go home. We recommend you rest for 2-3 days following the procedure. Pain at the injection site can occur, but is usually minimal.

Is the peripheral nerve block effective?

According to a recent study, dexamethasone was added to bupivacaine to achieve a nerve block in several patients. In the observational study, patients had a reduction of pain and longer pain relief with this block compared to bupivacaine alone. In a recent study, buprenorphine was found to prolong sciatic and brachial plexus nerve blocks by around 12 hours. In addition, clonidine and dexmedetomidine had a modest effect when used in nerve blocks.

Resources

Liu J, Richman KA, Grodofsky SR, Bhatt S, Huffman GR, Kelly JD 4th, et al. Is there a dose response of dexamethasone as adjuvant for supraclavicular brachial plexus nerve block? A prospective randomized double-blinded clinical study. J Clin Anesth. 2015;27(3):237–42. pmid:25637938

Williams BA, Butt MT, Zeller JR, Coffee S, Pippi MA. Multimodal perineural analgesia with combined bupivacaine-clonidine-buprenorphine-dexamethasone: safe in vivo and chemically compatible in solution. Pain Med. 2015;16(1):186–98. pmid:25339320

Williams BA, Ibinson JW, Mangione MP, Modrak RT, Tonarelli EJ, Rakesh H, et al. Research priorities regarding multimodal peripheral nerve blocks for postoperative analgesia and anesthesia based on hospital quality data extracted from over 1,300 cases (2011–2014). Pain Med. 2015;16(1):7–12. pmid:25377071

Williams BA, Ibinson JW, Mangione MP, Scanlan RL, Cohen PZ. Clinical benchmarks regarding multimodal peripheral nerve blocks for postoperative analgesia: observations regarding combined perineural midazolam-clonidine-buprenorphine-dexamethasone. Pain Med. 2015;16(1):1–6. pmid:25351887