Nerve Block Injections and Infusions

What is a nerve block? 

Medicines can be given around a nerve to lessen pain in that area of the body. One way to do this is to give the medicine as a single injection (shot). This is called a nerve block injection. 

Another way is to place a small catheter (tube) about the size of a fishing line along the nerve and connect it to a medicine pump. This is called a nerve block infusion. The pump will give your child a small amount of pain medicine continuously. 

Pain is a normal body reaction after surgery. But severe pain can slow recovery and have other unwanted effects

Why are nerve blocks used? 

When your child receives pain medicines by mouth as a pill or through an IV, some of the drug goes to the brain and can cause your child to feel sleepy. With nerve blocks, the drug does not go to the brain. Nerve blocks can control the pain without making your child too sleepy. 

It is important to reduce or prevent pain so your child can breathe deeply, get out of bed, and sleep in comfort. Since your child is more alert, he will know right away if he needs more pain medicine. Being alert and having good pain control makes it easier for your child to cough, sit up, and walk after surgery. These movements are important for your child to recover from surgery. 

Who gives the nerve block? 

An anesthesiologist gives the nerve block injection or places the infusion catheter during surgery after your child is asleep. An anesthesiologist is a doctor who specializes in managing pain.  

The catheter goes under the skin. It is taped into place to keep it from coming out by accident. Most children cannot feel the catheter or the medicines. 

Local anesthetics (numbing agents), among other medicines, are used for both nerve block injections and infusions. 

Most often, the nerve block infusion will remain in place for 2-7 days. At that point, your child will be able to relieve pain by taking medicines by mouth. Your child might also take pain medicines by mouth during the time the nerve block is in place. If he cannot swallow the pain medicines, the nurse will give them by IV. 

Are nerve blocks safe? 

Yes. The anesthesiologist will decide how much pain medicine is needed. This doctor will base that amount on your child’s age, body size, type of surgery, and overall medical condition. The doctor can speed up the rate if your child needs more pain relief or slow it down if there are unwanted side effects.  

If your child is an outpatient, the doctor may ask you to change the infusion rate. But you should never change the rate if the doctor has not told you to do so. 

If your child is an inpatient, the care team assesses your child’s pain at least 1 time each day to make sure he remains comfortable. The team will change the dose and infusion rate as needed. If your child goes home with a pain pump, the care team will train you to use that pump. 

Side effects of nerve block injections or infusions 

Any medicine used to manage pain can cause side effects. The most common side effects are numbness, tingling, and weakness in the limb that receives the medicine. It can make that part of the body feel heavy.  

Most often, these feelings lessen over time. Numbness in the painful area is helpful for reducing your child’s pain. Slowing the infusion rate or changing medicines will reduce this side effect. 

Other side effects include twitching, feeling dizzy or lightheaded, numbness around the mouth, ringing in the ears, vision problems, and a metal taste in the mouth. These side effects rarely occur but are very serious when they happen.  

If your child is an inpatient, tell the doctor or nurse right way if any of these side effects occur. If your child is outpatient and has one of these side effects, close the clamp on the pump right away and call the anesthesiologist.

Risks of nerve blocks 

Every type of pain relief medicine has its own risks. These risks include: 

• Temporary loss of feeling and no use of certain body parts 
• Odd feelings and pain 
• Bleeding inside the insertion site that may push on nerves and cause an injury 
• Infection 

Breakthrough pain 

It is possible your child could have pain after the nerve block. This is called breakthrough pain. If your child is old enough, the staff will ask him to use the pain scale to describe how much pain he is having.  

The care team will develop a treatment plan for breakthrough pain.  

Moving around with a nerve block 

One goal of giving pain medicine this way is to allow your child to move around better. Take care to keep any part of the tubing from being caught or pulled when your child is moving. 

If the catheter is in the leg, your child may get out of bed with help from the staff if the surgeon or other doctors say it is OK. Remember: Please call the nurse or physical therapist into the room each time your child gets out of bed. 

The pump is made so that your child will be able to move around easily. If your child leaves the hospital with a pain pump, your care team will tell you about further precautions. 

Removal of infusion catheter  

A doctor or nurse will use adhesive removal pads to make the tape come off easier.  

After the catheter is out, a self-stick bandage should be placed on the site. The bandage needs to stay in place for 1 day. 

When to call the care team 

You should call your child’s nurse if: 

• Your child seems is in pain 
• The heavy feeling in the arm or leg bothers him too much 
• The catheter (tube) connected to the nerve block infusion comes out or has come apart from the pump tubing 
• The dressing is loose 
• Your child has fever greater than 38˚C or 100.4˚F by mouth 
• The catheter is in a leg and your child needs help to turn or wants to get up 
• You have questions or concerns 

If you have questions or concerns about nerve block injections or infusions, please talk to your child’s doctor or anesthesiologist.