Nerve Block

A nerve block is a type of pain management that uses a local or regional anesthetic (a type of medicine) to block pain signals to the brain. When used to manage surgical pain, nerve blocks can reduce or eliminate the need for general anesthesia, reduce pain after surgery, and decrease or eliminate the need for opioids. Nerve blocks are also used to manage some types of chronic pain.

Anesthesia is a type of medicine used to prevent patients from feeling pain during surgery. It can make a patient’s whole body numb or just a specific part, depending on the patient and the procedure. The three types of anesthesia are:

• Local anesthesia, which only affects a small area and is used for minor procedures
• Regional anesthesia, which affects a larger area but does not cause unconsciousness
• General anesthesia, which affects the whole body; people under general anesthesia are unconscious and not aware of the surgery

Nerve blocks are a form of regional anesthesia and have several benefits:

• Reduced or eliminated need for opiate or narcotic medications
• Reduced exposure to general anesthetics
• Quicker recovery from surgery
• Less post-surgical pain
• Fewer side effects
• Shorter hospital stay
• No risk of dependence or addiction

A nerve block may be performed in the operating room or the preoperative area, depending on the procedure. In either case, a doctor who specializes in regional anesthesia will use a very thin needle to inject a numbing medication close to the area to be operated on. Ultrasound imaging will help the doctor guide the needle to the correct spot.

• If performed in the operating room, your child will be asleep under general anesthesia when they receive the nerve block and will not feel or remember the procedure.
• If your child receives a nerve block in the preoperative area, they will first receive local anesthesia and a sedative to minimize discomfort and help them relax. The sedative may make your child feel drowsy. Once the nerve block is complete, the surgical site will begin to feel numb.

In some cases, a nerve block is the primary method of pain management for the procedure. If this is the case for your child, they will also receive sedation during the procedure. In most other circumstances, your child will undergo general anesthesia in addition to the nerve block.

There are two ways nerve blocks can be used to manage pain after surgery.

1. The first option is a single injection of a local anesthetic. This medication will be active for a limited period of time after the procedure. This timeframe can range from a few hours up to 24 hours after surgery.
2. The second option is a peripheral nerve catheter. This catheter is a thin tube placed under the skin and attached to an infusion pump that administers a local anesthetic at a constant rate. Your child will wear the pump in a small pack after surgery for as long as the nerve block is needed to manage pain.

The Boston Children's Home Analgesia Program supports patients who are discharged with a nerve catheter. A regional anesthesia doctor manages the infusion pump until it is no longer needed. The catheter is then removed at home with the assistance of a Boston Children’s specialist via telehealth.

Peripheral nerve blocks are often used together with drugs such as acetaminophen (Tylenol), ibuprofen (Advil), and other medications for a comprehensive approach to pain control.

Pain relief from a nerve block can last several hours to several days, depending on the type of surgery and regional techniques used.

The risks associated with nerve blocks are quite low. There is small risk of infection, bleeding, or injury to the surrounding structures.