What is a nerve block injection or a nerve block infusion?
Medicines can be given around a nerve to lessen pain in that area of the body. One way to do this is to give the medicine as a single injection (shot). This is called a nerve block injection.
Another way is to place a small catheter (tube), about the size of a fishing line, along the nerve and connect it to a medicine pump. This is called a nerve block infusion. The pump will give your child a small amount of pain medicine at all times.
Pain is a normal body reaction after surgery. However, severe pain can slow recovery and have other unwanted effects.
Why would my child benefit from a nerve block injection or infusion rather than other methods of giving pain medicine?
When your child receives pain medicines by mouth as a pill or through an IV, some of the drug goes to the brain and can cause him to feel sleepy. When medicines are directed to the pain nerves, the drug does not go to the brain. For this reason, the nerve block injection or infusion may control the pain without making your child too sleepy.
We want to reduce or prevent pain so he can breathe deeply, get out of bed, and sleep in comfort. Since your child is more alert, he will know right away if he needs more pain medicine. Being alert and having good pain control makes it easier for your child to cough, sit up, and walk after surgery. All of these movements are crucial for your child to recover from surgery.
Who gives the nerve block injection or places the catheter for the infusion?
An anesthesiologist gives the nerve block injection or places the infusion catheter during surgery after your child is asleep. The anesthesiologist is a doctor who specializes in managing pain. The catheter will be tunneled under the skin and taped into place to keep it from coming out by accident.
Does it hurt to get medicines through a nerve block infusion?
No, most children cannot feel the catheter or the medicines at all.
What medicines would my child receive in a nerve block injection or infusion?
Local anesthetics (numbing agents), among other medicines, are used for both nerve block injections and infusions.
Is it safe to have a nerve block injection or infusion to control pain?
Yes. The anesthesiologist will decide how much pain medicine is needed. This doctor will base that amount on your child’s age, body size, type of surgery, and overall medical condition. The doctor can change the rate of infusion (how fast the medicine is given) based on your child’s needs. The doctor can speed up the rate if your child needs more pain relief or slow it down if there are unwanted side effects. If your child is an outpatient, the doctor may ask you to change the infusion rate. But, you should never change the rate if the doctor has not told you to do so.
If your child is an inpatient, the Pain Management Service (Pain Team), including the anesthesiologist, will assess his pain at least one (1) time each day to make sure he remains comfortable. The Pain Team will change the dose and infusion rate as needed. If your child goes home with a pain pump, you will be trained to use that pump and learn what to do if your child has pain or side effects.
Are there side effects with nerve block injections or infusions?
Yes. Any medicine used to manage pain can cause side effects. If side effects occur, the anesthesiologist will adjust the medicines to make your child feel better. The most common side effects are numbness, tingling, and weakness in the limb that receives the medicine. It can make that part of the body feel heavy. Most often, these feelings lessen over time. Numbness in the painful area is helpful for reducing your child’s pain. Slowing the infusion rate or changing medicines will reduce this side effect.
Other side effects include twitching, feeling dizzy or lightheaded, numbness around the mouth, ringing in the ears, vision problems, and a metal taste in the mouth. These side effects rarely occur but are very serious when they happen. If your child is an inpatient, tell the doctor or nurse right way if any of these side effects occur. If your child is outpatient and has one of these side effects, close the clamp on the pump right away and call the anesthesiologist.
Could my child still have pain?
Yes. It is called breakthrough pain. If your child is old enough, the staff will ask him to use the pain scale to describe how much pain he is having. For different age groups, different pain scales are used. To learn more about the pain scale, see “Do you know… What you can do to help your child in pain.”
When your child has breakthrough pain, the nurse might give more pain medicine through the IV. The Pain Team also might increase the amount of pain medicine given through the nerve block infusion.
While my child has the nerve block infusion or injection, can he move the arm or leg where the injection was given or the catheter was placed?
One goal of giving pain medicine this way is to allow your child to move around better. Take care to keep any part of the tubing from being caught or pulled when your child is moving.
While inpatient: If the catheter is in the leg, your child may get out of bed with help from the staff, if the surgeon or other doctors say it is OK. Remember: Please call the nurse or physical therapist into the room each time your child gets out of bed.
The pump is made so that your child will be able to move around easily. If your child leaves the hospital with a pain pump, you will be told about any further precautions.
When should I call for the nurse if my child is inpatient?
You should call your child’s nurse:
- If your child seems to be in pain;
- If the heavy feeling in the arm or leg bothers him too much;
- If the catheter (tube) connected to the nerve block infusion comes out or has come apart from the pump tubing;
- If the dressing is loose;
- If your child has fever greater than 38 degrees C by mouth;
- If the catheter is in a leg and your child needs help to turn or wants get up; or
- If you have questions or concerns.
How will I know if my child is doing well with the nerve block injection or infusion?
If your child is inpatient, the nurse and the Pain Team will be looking at these things to make sure he is doing well with the nerve block injection or infusion:
- Your child’s pain level
- The connections of all parts of the infusion system
- The condition of the dressing that holds the catheter in place
At times, they will ask your child to move his arms or legs. This is important to make sure the medicine or catheter is not causing any serious side effects.
If your child becomes an outpatient with an infusion pump, the staff will give you a handout that describes how the pump works, what problems to look for, and who to call if you have questions.
How else can I help my child?
Feel free to ask the staff for help. They are here 24 hours a day for you and your child. The nurses, physical therapists, occupational therapists, psychologists, and Child Life specialists can tell you some easy ways to help your child cope with fears or pain. Simple things that distract him will help, such as reading stories, blowing pinwheels, listening to music, coloring, and massages. You and the staff will soon discover what works best for your child.
Are there risks with nerve block injections and infusions?
Every type of pain relief medicine has its own risks. During the informed consent process, the staff talked to you about the risks and benefits of a nerve block injection or a nerve block infusion. These risks include:
- Temporary loss of feeling and no use of certain body parts;
- Odd feelings and pain;
- Bleeding inside the insertion site that may push on nerves and cause an injury; and
If you have questions or concerns about nerve block injections or infusions, please talk to your child’s doctor or anesthesiologist.
How long can the nerve block infusion be used?
Most often, the nerve block infusion will remain in place for 2 to 7 days. At that point, your child will be able to relieve his pain by taking medicines by mouth. Your child might also take pain medicines by mouth during the time the nerve block is in place. If he cannot swallow the pain medicines, the nurse will give them by IV.
How will the infusion catheter be removed from my child?
This process is fairly painless. If your child is inpatient, a doctor or nurse will use adhesive removal pads to make the tape come off easier. Then, one of them will remove the catheter. If your child is outpatient, the nerve block catheter will be removed in the Pain Clinic by the anesthesiologist or clinical nurse specialist.
After the catheter is out, a self-stick bandage should be placed on the site. The bandage needs to stay in place for one (1) day.
If you have questions or concerns about your child having a nerve block injection or infusion for pain relief, please talk to the doctor or nurse. If your child is an outpatient, call 901-595-3300 and ask for the anesthesiologist on call. If you are outside the Memphis area, dial toll-free 1-866-2STJUDE (1-866-278-5833), and press 0 when the call connects.
This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.
St. Jude complies with health care-related federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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