Regional Anesthesia and Acute Pain Services

Types of Pain Relief

• Oral or intravenous medications ranging from acetaminophen and non-steroidal anti-inflammatory (NSAIDS) drugs to anti-seizure medications (for treating “burning” or “electric” nerve pain) to opiates (medications originally derived from the opium poppy) are all effective for treating pain. When more methods of treating pain are used (not relying on higher doses of only one class of drugs), the outcome for the patient is typically better for pain control and reducing side effects.
  
  
• Regional (local) nerve blocks — the injection of local anesthetic onto or near nerves for temporary control of pain. A group of nerves, called a plexus or ganglion, that receives pain signals from a specific organ or body region can be blocked with the injection of medication into a specific body area. When pain relief requires an invasive procedure, such as the insertion of a needle for a nerve block, patients are often given sedation in advance.
  
  Blocks can be provided before as well as after surgery. A block given before surgery may reduce the amount of general anesthetic needed and help minimize side effects after surgery including nausea and vomiting.
  
  Different types of nerve blocks are used to target specific areas of the body:
  
  Lower Body
  • Hip or thigh
    
    Lumbar plexus nerve block — Froedtert & The Medical College of Wisconsin are unique in the state in offering this type of nerve block, the only peripheral nerve block with significant benefit in alleviating pain in the immediate postoperative period after hip surgery. An alternative method would be to employ an epidural nerve block. However, not only would an epidural numb the non-operative leg, but it could put patients (on blood thinners) at risk of bleeding into the epidural space. As patients receiving a hip replacement are routinely placed on blood thinners after surgery, the use of a lumbar plexus nerve block alleviates much of this concern.
    
    
  • Knee or thigh
    
    Femoral nerve block/sciatic nerve block — Froedtert & The Medical College of Wisconsin are unique in southeastern Wisconsin in offering both of these peripheral nerve blocks to most patients for pain relief after knee replacement surgery. The blocks numb both the front (femoral) and back (sciatic) of the knee, reducing postoperative pain while sparing the strength of the other extremity. Having strength in the non-operative leg offers patients much greater mobility after surgery compared to those receiving an epidural. (At other healthcare institutions, patients are typically only offered a femoral nerve block and often have pain in the back of the knee.)
    
    
  • Foot and ankle
    
    Popliteal or ankle block — by injecting medication near the peripheral nerves behind the knee or at the ankle, just the operative foot can be numbed during surgery. This can leave the other extremities intact for patient function after surgery. The use of a nerve block is the best method of treating bone pain and minimizes the side effects of other medications, such as nausea and vomiting after receiving opioids.
  
  Upper Body
  
  
  • Shoulder
    
    Interscalene nerve block — this typically superficial nerve block in the side of the neck can be extremely effective in treating pain after shoulder surgery, up to and including total shoulder replacements. The neck is a nerve-rich area, and local anesthesia can temporarily numb the voice box, one of the breathing muscles or the eyelid in addition to the shoulder. However, side effects to this nerve block are typically short-lived and well worth the pain relief afforded to patients undergoing shoulder surgery.
    
    
  • Arm or hand
    
    Brachial plexus blocks — a variety of approaches (supraclavicular, infraclavicular, axillary, elbow or wrist blocks) can be used to numb the operative arm and hand. By placing local anesthesia around the nerves going to the operative arm or hand, only that extremity can be numbed for pain control. This can leave the other extremities intact for patient function after surgery. The use of a nerve block is the best method of treating bony pain, and minimizes the side effects of other medications, such as nausea and vomiting after receiving opioids.
    
  Trunk of the Body
  • Breast
    
    Paravertebral nerve block — Froedtert & The Medical College of Wisconsin are one of only a few healthcare facilities in Wisconsin offering this type of nerve block for patients having breast and abdominal surgery. A paravertebral nerve block involves injecting local anesthetic into spaces off to the side of the vertebrae. This is the one of the most effective types of nerve blocks possible and does not involve placing a needle into the epidural or spinal space. Benefits of using this block (versus epidural anesthesia) include better blood pressure control and lack of leg weakness/numbness after surgery.
    
    
  • Abdomen
    
    Thoracic/lumbar epidural — epidural anesthesia is commonly placed in the lower back (lumbar region) for surgeries on the lower extremities, similar to what is done for women in labor. This technique may also be done in the mid- to upper-back (thoracic region) for surgery in the area of the chest or abdomen.
    

Patient-Controlled Pain Relief

For most nerve blocks and epidurals, patients are able to control how much pain relief they receive. The pain medication is delivered into the body by a pump attached to the nerve block catheter or epidural catheter. If the patient is in pain, he or she can press a button to deliver an extra dose of medication from the pump. The pump is safety-programmed to prevent too much medication from being released. Patient-controlled pain administration often eliminates the need to call a nurse if pain worsens or if the patient is anticipating an increase in pain, such as can occur with physical therapy.

Exceptional Staff

Author: Marla Fraunfelder

Last Review Date: July 25, 2009