Anesthesia Services : Acute Pain Management

Consultants in Pain Management, Inc. is a subgroup of Atlantic Anesthesia anesthesiologists who will evaluate and manage your acute post-operative pain or other acute pain issues.

Acute pain management frequently includes the use of Patient Controlled Analgesia (PCA) pumps that safely allow you self administer narcotic pain medication in a safe, computer controlled manner when you need it. Other acute pain management plans include epidural analgesia which provides days of pain relief for complex abdominal and chest Surgery, and special nerve blocks that provide initial post-operative pain for several hours. These options can be discussed with your anesthesiologist. Let your anesthesiologist know if you are receiving treatment for chronic pain management. This will be taken into consideration during the treatment of your acute pain.

Peripheral Nerve Block

Stopping pain signals that travel through a nerve or nerves can be an effective way of treating pain. Often special nerves must be blocked by a special technique known as nerve blocks. Various medications used with nerve blocks include local anesthetics, steroids and bretylium. These injections may block pain, reduce swelling, decrease muscle spasm and/or improve motion. Types of blocks include: trigger point injections, sympathetic ganglion blocks, epidural steroid injections and others.

Common Nerve Block Types

Interscalene Nerve Block
This type of nerve block numbs a bundle of nerves just above your collarbone. It is commonly used for shoulder or upper-arm surgeries.

Femoral Nerve Block
The femoral nerve is located in the front of your upper thigh, a few inches below your hip bone. This nerve is numbed for operations such as knee replacements and reconstructions.

Popliteal Nerve Block
This block is performed above the crease at the back of your knee, usually for foot and ankle surgeries. It can be used also for knee surgeries.

Key Benefits of Nerve Blocks
1 Better Pain Control
The main reason patients choose a nerve block is pain relief. Often this benefit lasts through the first night after surgery and into the next morning. Some patients who receive nerve blocks wake up after surgery with absolutely no pain. This result is not guaranteed, and you are more likely to experience mild but tolerable pain after most surgeries. But with a nerve block, you can rest assured that your pain will be controlled when you wake up.
2 Quicker Start in Rehab
A restful night’s sleep and minimal pain the morning after surgery makes it possible to begin your rehab earlier. Patients who receive nerve blocks are typically up and around, with the help of therapists, much more easily on their first recovery day.
3 Fewer Side Effects
An effective nerve block allows many patients to receive a “lighter” anesthetic, which has fewer side effects. This can mean a much lower chance of nausea, drowsiness, itching and confusion after surgery. A nerve block will also reduce your need for powerful narcotics and their common side effects.
4 Less Likely Use of Breathing Tube
In many cases, using nerve blocks also makes it possible to perform surgeries without breathing tubes. If your operation doesn’t require a breathing tube, you will be much less likely to experience a sore throat following surgery.
Nerve Block Procedure

Preparing for Surgery
Usually, the discomfort patients experience from nerve blocks is similar to that from getting an IV. During your nerve block, an anesthesiologist will offer sedation to improve your comfort and lessen anxiety. A nurse will monitor your vital signs and give you additional sedation, if needed. Then we will clean your skin and locate the exact position of the nerves to be numbed. We use ultrasound for this positioning, which enhances the safety, efficiency and comfort of your procedure. After locating the nerves with ultrasound, your anesthesiologist will carefully inject local anesthetic into the surrounding area using a needle similar in size to an IV. During the next 10-30 minutes, your limb will become warm, heavy, and eventually numb.

Following Surgery
After surgery and until the block wears off, be very careful “carrying” your numb limb. Protect it from hot or cold, as numbness can prevent you from sensing harmful temperatures. Always follow any directions from your surgeon about icing the surgical site, but do not place ice directly on your skin. Also avoid putting pressure on the limb, and never try to walk on a numb leg.

Your safety is so important to Atlantic Anesthesia that one of our nurses will contact you the day after your surgery. If you have any concerns before receiving this call, please call us using the numbers on back of this brochure.

Nerve Block Frequently Asked Questions
How long will the nerve block last?
Your nerve block will last through about six hours of surgery and provide pain relief for about 24 hours. In some cases the block will wear off sooner than 24 hours, and in others it will last as long as 30 hours.
Will I be able to tell when it's wearing off?
When your nerve block begins to wear off, you might notice some return of sensation or ability to move the body part that was numbed. Any increase in pain from the surgical site usually also indicates that your block is wearing off. It is important to follow your surgeon’s or anesthesiologist’s instructions about the best time to begin taking pain medicine and to do so before your block wears off completely.
What are the risks of a nerve block?

Every method of pain relief has its risks, and a nerve block is no exception. Most of the risks associated with nerve blocks are not serious, and side effects are almost always temporary. Nerve damage from a nerve block may be evident in the form of numbness, tingling or abnormal sensation, weakness, or pain. Any of these problems almost always improves by itself, and permanent nerve damage is very rare. As with any procedure where a needle is used bruising can occur, especially for patients taking blood-thinners. Inadequate numbing or pain relief occurs in fewer than five out of one-hundred nerve blocks. Very rarely, a patient can have a serious reaction to the local anesthetic itself.