Nerve Blocks

TMPaul · Jan 17, 2005

Does anyone know anything about nerve blocks for pain management? What is involved in administering them, do they tend to work well, etc.
TIA
Ann

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Nesher, BSN, RN · Jan 18, 2005

I had one this summer following a repair for a torn ligament in my wrist. I hated it! The dead arm that I had to move around, the hitting myself in the face, the fact that it lasted 24 hours - all very annoying. It was supposed to take care of the pain, but I would have preferrred the pain. I think that blocking other body areas might be less annoying and erhaps effective. My block was done by the anesthsiologist after I had been sedated - he went somewhere under my arm to access the nerve he used.

Another aspect that was a bit hrd to take - the doc used marcane which is seemes is derived from cocaine - I spent the night awake, but very sleepy from the general - counting the hours hoping the block would finally depart.

mwbeah · Jan 18, 2005

the doc used marcane which is seemes is derived from cocaine - I spent the night awake, but very sleepy from the general - counting the hours hoping the block would finally depart.

Just some clarification (your information is incorrect), marcaine is an amide local anesthetic and cocaine is an ester local anesthetic. Marcaine is a synthetic local anesthetic, no relation. This excerpt may help a little:

"THE DEVELOPMENT OF THE LOCAL ANESTHETICS

The revolution in the history of local anesthetics broke in 1904, when Einhorn troduced novocaine (procaine), a local anesthetic with fewer side effects than cocaine[20]. Nevertheless, the duration of its action has been short-lived, a fact which has limited its use for the most part to operations with a short duration. This problem was solved by Braun, who proposed the addition of adrenaline to the local anesthetic, for the purpose of prolonging both the duration and the validity of the local anesthetic[11].

In the year 1928, Eisleb composes tetracaine (pantocaine) a substance with higher anesthetic power and higher duration of action[21]. This progress has come up against the problem of the higher degree of toxicity as compared with procaine. Both these local anesthetics belong to the group of aminoalkylesters[40].

In 1943 Nils Loefgren composed lidocaine, which belongs to the group of aminoalcylamids[36,37]. Loefgren' remark with regard to the common structural principle of the local anesthetics; In short, that the local anesthetics have a lipophilic and one hydrophilic end was significant. The lipophilic term usually consists one aromatic and one heterocyclic group and is connected to the hydrophile end which consists, as a rule, of a secondary or tertiary group of amines, through a chain which defines the extent to which the local anesthetics originate from the group of the esters or the group of amides. Beyond any doubt, the lidocaine has been the main substance and, at the same time, the base for all the later studies of the local anesthetics that followed. The later researches led to the discovery of new local anesthesia such as etidocaine, the prilocaine, and the bupivacaine, focused initially 12: on the relation between the chemical structure of the anesthetic and its anesthetic action, on the physical and chemical properties of the local anesthetic through variations on the points of restoration of the hydrophile or lipophile groups or the intermediate chain, on the beginning of action, the power, the duration of the action and toxicity, the place of action of the anesthetics, on features, such as the alcalic nature, the fat-solubility the water solubility of the base and the proteinic charge."

A regional block for surgery is an excellent way to alleviate the hyperalgesia that occurs post surgery by inhibiting peripheral sensitization. Central sensitization can be preempted by the use of NMDA receptor antagonists and later by COX inhibitors.

Nesher, BSN, RN · Jan 19, 2005

Thanks for the clarification on marcaine. My friend, a nurse gave me the bit on it being related to cocaine. It was my day of surgery and I didn't look it up to check - just goes to show you should always double check! Thanks again.

charles-thor · Jan 26, 2005

mwbeah,

I guess this would be more appropriately placed in the CRNA thread, but since it's already here, I'll ask. In your experience, have you seen good results with attenuating central sensitization with pre-emptive IV ketamine? Thanks.

mwbeah · Jan 27, 2005

I do, I use 0.5 mg/kg mixed with propofol on induction and find my narcotic requirement intraop and postop to be much less versus when I did not use it. My research found it to be more effective in females (significantly more effective, but males showed trends that if we had a larger sample size may have been significant).

Mike

Traveler · Jan 27, 2005

I thank all for their responses. I should have specified in my question that I was inquiring about nerve blocks for chronic pain management. What types of medications are used, how long do they normally last, is there loss of function, are there long term negative consequenses, etc?

Thanks,

Ann

TawneyCat · Aug 19, 2005

Hi, Traveler.

I work at a chronic pain management clinic. We perform literally 100's of different "nerve blocks" as you are calling them. Mostly neck, including head and arm pain; and back, including hip and leg pain. Some are performed in an outpatient setting, others are performed in a treatment room. It depends on your chronic condition and what "nerves" are ultimately involved. Lots of people get good relief from the "blocks", from several months with some to 1-2 years with others. Injectables vary, including numbing medicines and steroids. A good Dr will use fluoroscopy with some light sedation for comfort. There is no permanent loss of function. Numbness can occur and may last for several hours afterwards, but movement returns fully. Most pain management clinics require a referral from your treating physician. There aren't very many pain clinics out there. Well, good ones, anyway. We have patients travel as many as 2-3 hours to be seen. I thought I could touch on a good website listing available pain managment doctors, but my own doctor isn't listed on the one I looked at, so a little more research is required on my part for that bit of info. Hope this helps a little.