Nerve Blocks Before Surgery

Nerve blocks are a type of medical procedure commonly used in various medical contexts, including before surgery. A nerve block involves the injection of a numbing medication (local anesthetic) near a specific nerve or group of nerves to temporarily block the sensation of pain in a particular area of the body. The goal is to provide pain relief during and after a surgical procedure.

Types of Nerve Blocks

Common types of nerve blocks include:

• Peripheral Nerve Blocks: These target specific nerves outside the spinal cord and are often used for procedures involving the limbs.
• Epidural Blocks: These involve injecting an anesthetic into the epidural space around the spinal cord, providing pain relief for procedures involving the lower abdomen, pelvis, and lower extremities.
• Spinal Blocks (Subarachnoid Blocks): These involve injecting anesthetic into the cerebrospinal fluid within the spinal canal, providing pain relief for procedures such as cesarean sections.

Indications 

Before surgery, nerve blocks may be administered for several reasons, such as the following:

• Pain Management: Nerve blocks are effective in managing pain and can provide more targeted pain relief than general anesthesia alone. By blocking the transmission of pain signals from a specific region of the body to the brain, patients may experience reduced pain during and after surgery.
• Reduced need for General Anesthesia: In some cases, nerve blocks allow for a decrease in the amount of general anesthesia required. This can be beneficial for certain patients, especially those who may not tolerate general anesthesia well, or who have underlying health concerns.
• Postoperative Pain Control: Nerve blocks can contribute to effective postoperative pain control, potentially reducing the need for opioid medications and their associated side effects.
• Faster Recovery: By minimizing pain during and after surgery, nerve blocks can contribute to a more comfortable recovery process. Patients may be able to start moving and engaging in rehabilitation sooner, promoting a faster recovery.

Nerve blocks are not for everyone, and your anesthesiologist will evaluate whether it is the right option for you.

Contraindications

If you are going to have surgery, talk to your anesthesiologist or surgeon beforehand to ask if you are eligible for a nerve block. A nerve block may not be suitable in the following circumstances:

• If you have an infection at the site where the injection is to be made
• If you have a bleeding disorder
• If you are taking an anticoagulant (a drug such as warfarin that prevents blood clots) that you have not stopped ahead of time
• If you have had problems with the nerve in the area to be targeted by the injection

Preparation

Pre-procedure preparation for a nerve block may include the following:

• A review of your medical history and a complete physical examination
• Routine blood work, imaging, and other tests specific to your condition
• Informing your doctor of any allergies to medications, anesthesia, or latex
• A review of your medications and the need to refrain from certain medications for a specified period
• Arranging for someone to drive you home following the procedure
• Signing a consent form after the pros and cons of the procedure have been explained

Procedure

An anesthesiologist will choose the type of nerve block suited to you based on several factors, including your general health and the surgical procedure you are about to undergo. Depending on the operation you are having, the nerve block may be administered at the side of the neck, around the collar bone, near the armpit, in your groin, at the front of the thigh, behind your knee, at your ankle, or in the spinal area.  The nerve block is done predominantly under ultrasound guidance. This technique allows the anesthesiologist to visualize the needle direction and local anesthetic injection in “real time.” In general, the procedure involves the following steps:

• The skin over the injection site is cleaned and sterilized to minimize the risk of infection.
• A small amount of local anesthetic may be injected into the skin at the site where the main nerve block injection will occur. This helps to numb the skin and reduce the discomfort of the injection.
• Using imaging guidance (such as ultrasound or fluoroscopy) or relying on anatomical landmarks, the healthcare provider inserts a needle through the skin to reach the targeted nerve or nerve plexus.
• Once the needle is properly positioned, the local anesthetic or a combination of medications is injected around the nerve or nerve bundle. The anesthetic temporarily blocks the transmission of pain signals.
• In some cases, nerve stimulators or imaging may be used to confirm the accurate placement of the needle and the spread of the anesthetic.
• A nerve block typically takes less than 10 minutes to administer and up to 30 minutes to take full effect.

Post-procedure care

After your nerve block is administered, you will be observed for a period to ensure there are no immediate complications. Post-procedure instructions include:

• Pain management with the use of over-the-counter pain medications or prescription medications.
• Application of ice to the injection site to help reduce swelling and provide additional pain relief.
• Adequate rest and recovery for a certain period to allow the body to heal.
• You should avoid strenuous activities such as heavy lifting, vigorous exercise, or activities that could strain the affected area.
• A follow-up appointment will be scheduled  to assess the effectiveness of the nerve block and address any concerns or questions.

Risks and Complications

Possible risks and complications of a nerve block include:

• Infection
• Bleeding
• Headache
• Nerve damage
• Allergic reactions
• Numbness or weakness
• Puncture of surroundings structures

Benefits

Some of the benefits of nerve blocks include:

• Avoidance of general anesthesia
• Reduced need for opioids
• Better pain control
• Quicker recovery
• Shorter hospital stay
• Minimal side effects
• Improved surgical outcomes

Summary

A nerve block decreases your pain during and after surgery.  It is more effective than pain medications given through an intravenous (IV) line. Because you have less pain, you will need less oral or IV pain medication, even though you will have those medications available to you. You will also have fewer side effects of pain medications, such as respiratory depression, itching, nausea, and drowsiness.