Should You Get a Peripheral Nerve Block instead of General Anesthesia?

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By Pooja Pandya, MD

If you have a surgery scheduled, chances are good that your chief concern about the anesthesia is simply that it works – that you sleep through the entire procedure and feel minimal pain afterward. The most common scenario for achieving that goal is general anesthesia: a combination of drugs delivered intravenously and inhaled gases that put you into a deep slumber during which you feel nothing.

Effectively a medically induced coma, general anesthesia does the trick safely. But it can also come with side effects once you regain consciousness, including nausea and vomiting, temporary confusion and dizziness, shivering, and a sore throat caused by the breathing tube.

Fortunately, for some types of surgeries there are other options that are just as effective at inhibiting pain – and they come with fewer potential side effects, while allowing you to recover more quickly. One leading option is the peripheral nerve block, a form of regional anesthesia in which an anesthesiologist inserts a fine needle using ultrasound near a cluster of nerves to numb just the area of the body needing surgery. Unlike other forms of regional anesthesia, such as spinal blocks and epidurals, which usually numb you from the entire waist down, peripheral nerve blocks anesthetize smaller and more specific areas of the body. The injection stops the peripheral nerves, which run from the spinal cord to the rest of the body, from relaying pain signals to the brain.

Nerve blocks have been around for decades, but in the last 20 years, improved ultrasound guidance has increased their precision and safety, making them a more viable option for procedures. If you’re planning to have surgery, consider talking to your anesthesiologist to see if a nerve block would be a good choice for you.

Uses of Nerve Blocks

Peripheral nerve blocks are most often used for orthopedic surgeries on the arms, hands, shoulders, legs and feet. Common nerve blocks include upper extremity blocks such as brachial plexus blocks, which numb your arm, or lower extremity nerve blocks, such as femoral or popliteal blocks. Nerve blocks are especially good for pain control after knee and shoulder replacements, and fractures of the upper and lower extremities, such as if you break your wrist or ankle.

For those who may be at increased risk under general anesthesia, peripheral nerve blocks can be a helpful option. This includes patients with sleep apnea, who are more sensitive to narcotics and sedative medications, and people who have lung diseases such as chronic obstructive pulmonary lung disease (COPD), because it is more difficult for them to recover after the use of the breathing tube.

Because peripheral nerve blocks are injections that wear off, they are not considered a sustainable option for chronic pain, though they may provide short-term relief for some painful conditions when other treatments have not been successful.

Benefits and Risks

Nerve blocks are often combined with sedation because many people prefer to be relaxed or asleep during a procedure. Nerve blocks also provide short-term pain relief after a surgery; this can be especially helpful for fractures, which are often very painful after they are fixed with plates or screws. This extended pain relief reduces the need for painkillers, especially opioids, which can cause chemical dependency in as little as a week. And narcotics come with their own potential side effects, including constipation, drowsiness, and nausea.

Patients who have peripheral nerve blocks instead of general anesthesia for surgery tend to recover more quickly from the procedure. This means they typically go home sooner and can begin physical therapy more quickly, which promotes faster healing and better outcomes.

As with any medical procedure or mode of anesthesia, there are some risks with peripheral nerve blocks, though they are very low. They include bleeding and infection at the injection site. And there is always the risk of permanent nerve damage, though that risk is also minimal and can be mitigated by your doctor checking to see if you have any pre-existing nerve damage before choosing a nerve block.

No matter what anesthesia you and your doctor determine is right for you, talk with your physician about what to expect on the day of the surgery so you can be as relaxed and comfortable as possible. The most important thing is that your surgery is safe and your recovery goes as smoothly as possible.

To learn more about peripheral nerve blocks, visit the Kaiser Permanente site or the site of the American Society of Regional Anesthesia and Pain Medicine.

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