A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.
More needles … who wants that? You probably do! Nerve block anesthesia, also called regional anesthesia, requires localized numbing and additional needle sticks, but it has many advantages. Primarily, it can have a profound effect on your pain after surgery, and improve your rehabilitation and decrease your risk of complications.
Pain is a devilish thing. After surgery, it keeps you bedridden and prevents joints from moving and healing. Traditional treatment of pain with narcotics makes us lazy, so we want to lie around after surgery longer than we should. This increases our chances of blood clots and breathing problems from allowing our blood to sludge and lungs to poorly inflate while we lie around like a couch-potato.
Major joint surgery can be very painful. When the knee is replaced, a brace is placed on the leg and connected to a motor to keep the joint moving. This happens right after the surgery. That would be the equivalent of asking you to do sit-ups the day after your abdominal surgery.
So, how do nerve blocks help us heal? Nerve blocks numb the intended part of the body by injecting an anesthetic close to the nerves that supply it with feeling. Local anesthetic is used after sedation before surgery to numb the nerves closest to the area of the body requiring surgery. Next, a catheter or tube is inserted close to the nerves and secured. The catheter is connected to a pump that provides local anesthetic and narcotics until the catheter is removed. The medicine does not go directly into the blood stream as with other I.V. and oral narcotics, which eliminates most of the side effects. Regional anesthesia decreases nausea, vomiting and sleepiness caused by I.V. and oral narcotics.
Better pain management means you get out of bed and walk sooner. This increased earlier mobility leads to additional advantages. These include shorter hospital stays, improved breathing, fewer clots, shorter rehabilitation, and potentially earlier return to work or normal activities.
In the past, we used nerve stimulators alone to help us locate the nerves for correct placement of the local anesthetic. Now we have ultrasound to guide us. We can see exactly where the local anesthetic and needles should be placed, next to the desired nerves. Now the blocks can be performed quicker and more accurately.
So, do you want an extra needle stick for a nerve block when you have surgery? Your surgeon and physician anesthesiologist will likely recommend it for many operations, and virtually every patient is saying yes.
Susan G. Curling is an anesthesiologist.
