A nerve block is a surgical or nonsurgical treatment modality that seeks to produce an anesthetic pain relief effect by blocking nerves from relaying pain signals to the brain. Nonsurgical nerve blocks involve injections of an anesthetic medication around a targeted nerve or a bundle of nerves. The anesthetic prevents the targeted nerves from relaying pain impulses to the central nervous system (CNS), leading to a significant reduction in pain. Rather than feeling pain, the part of your body serviced by the targeted nerve will feel numb or you might even feel a “pins and needles” sensation. Surgical nerve blocks require a surgeon to physically cut or destroy a targeted nerve in order to prevent it from relaying pain impulses to the central nervous system. A nonsurgical nerve block can last anywhere from 12 to 36 hours, depending on the type of anesthetic used and the dose delivered; surgical nerve blocks, on the other hand, may be permanent depending on whether or not the nerve is able to repair itself.
A nerve block can be used to block pain signals from being transmitted by a wide variety of nerves and/or nerve bundles. Nerve blocks can be used to prevent or control pain caused by surgery, arthritis, headaches, phantom pain following amputation, and accidents or trauma. Your physician will decide which nerve to treat based on the location and severity of your pain. Some common examples of nerve blocks used by Pain Consultants of West Florida include:
Upper Extremities:
- Occipital Nerve Block – the occipital nerve originates near the second or third vertebrae of the cervical spine. An occipital nerve block can be used to treat pain caused by headaches and/or trauma to the cervical spine that generates an occipital nerve impingement.
- Brachial Plexus Nerve Block- the brachial plexus is a group of nerves located in the neck and continue down the arm. They are responsible for sending signals to your shoulders, arms, and hands. A brachial plexus block is a regional anesthesia technique that may be used to block sensation and the ability to move in the upper extremities.
- Axillary Nerve Block – the axillary nerve is responsible for relaying pain signals from the arm and hand to the central nervous system. Blocks of this nerve can be used during recovery from surgery, or to treat pain in the arm and hand.
- Ulnar Nerve Block – the ulnar nerve is responsible for relaying pain signals from the wrist to the central nervous system. A block of this nerve can be used to control and eliminate pain in the wrist and hand. They are typically administered in conjunction with a carpal tunnel (median) nerve block.
- Carpal Tunnel (Median) Nerve Block – the carpal tunnel (median) nerve is responsible for relaying sensory information from the hand and wrist to the central nervous system. They are often used in conjunction with an ulnar nerve block.
- Suprascapular Nerve Block – the suprascapular nerve is responsible for relaying sensory information from the shoulder joint to the central nervous system. Blocks of this nerve can be used to provide relief from shoulder pain, whether it is acute or chronic. These blocks are generally used in combination with an axillary nerve block to provide total pain relief to the shoulder and upper arm.
Lower Extremities:
- Sympathetic Nerve Block – sympathetic nerves are those nerves that make up the sympathetic nervous system, which controls involuntary bodily functions. These nerves are found in bundles of nerves called ganglions near the spine. A sympathetic nerve block can be used to treat pain in the neck, back and lower body.
- Genicular Nerve Block – the genicular nerve is responsible for carrying pain signals from the knee to the central nervous system. The pain relief will only last as long as the anesthetic, so genicular nerve blocks are generally used as a diagnostic tool to determine whether or not a radiofrequency ablation will provide long-term pain relief.
- Saphenous Nerve Block – the saphenous nerve is responsible for carrying pain signals from the leg to the central nervous system. Similar to the genicular nerve block, these procedures are generally used as diagnostic tools to determine whether or not a more permanent nerve block will be successful in controlling a patient’s pain.
- Ankle Nerve Block – pain in the ankle can sometimes be controlled by performing nerve blocks on the nerves that innervated the ankle. These procedures can be used on their own or coupled with other treatments to have a dual effect on pain control.
- Stellate Ganglion Nerve Block- he stellate ganglion is a collection of sympathetic nerves located in the neck along either side of the voice box. A stellate ganglion block may be used to treat nerve pain in the head, neck, upper chest, or upper arm that has been unresponsive to other treatments.
- Inferior Alveolar Nerve Block- the inferior alveolar nerve is part of the posterior mandibular nerve. An inferior alveolar nerve block can be used to block pain for procedures involving the lower jaw.
- Lumbar Sympathetic Nerve Block- the lumbar sympathetic nerves are located along either side of the spine in the lower back. This can be used to treat lower back and leg pain, specifically pain linked to reflex sympathetic dystrophy or complex regional pain syndrome, that has been unresponsive to other treatment options.
- Hypogastric Plexus Block – the hypogastric plexus is a collection of nerves located near the lower part of the abdomen in the upper front of the pelvis. The hypogastric plexus block can be used to treat chronic pelvic pain that is unresponsive to oral medications allowing patients to experience more relief while taking less pain medication.
Face:
- Thoracic Nerve Block– the thoracic nerves are found in the upper body. While they are located in the chest region, the nerve fibers are considered spinal nerves. A thoracic nerve block is used to isolate and identify the root nerve causing thoracic pain while helping to reduce or eliminate the pain.
- Intercostal Nerve block– the intercostal nerves are located beneath the ribs which cause pain to the chest area. Blocking the nerve with the intercostal nerve block can be successful for treating pain caused by herpes zoster (shingles) infections or surgical incisions and to hep diagnose the source of chest pain.
- Sphenopalatine Nerve Block – the sphenopalatine is a bundle of nerves located in the bones of the face. It is a very common cause of headaches and facial pain caused by trigeminal neuralgia, shingles of the face, and facial cancer or trauma, so blocking this nerve with an injection of anesthetics is a very effective treatment method.
- Botox – while most nerve blocks are performed with a general anesthetic like lidocaine, certain nerve blocks use botulinum toxin (Botox), particularly in the treatment of migraines and cervical dystonia.
Abdomen:
- Transverse Abdominis Plane Block (TAP)– the transverse abdominis plane (TAP) refers to the nerves making up the anterior abdominal wall. A transverse abdominis plane (TAP) block is used to anesthetize those nerves and is quite effective as a postoperative treatment for pain management.
- Ilioinguinal Nerve Block– the ilioinguinal nerve is the nerve responsible for providing sensation to the inner thigh, including the root of the penis and upper scrotum in men and portions of the pubic area in women. The ilioinguinal nerve block can provide pain relief to the area caused by nerve damaged through surgery or scar tissue following hernia repair. It can also be used to help diagnose the cause of pain in the region.
- Genitofemoral Nerve Block– the genitofemoral nerve is a nerve found in the abdomen that supplies sensation to the upper thigh as well as the anterior scrotum in men and mons pubis in women. The genitofemoral nerve block can be used to help diagnose genitofemoral neuralgia and to help manage pain that has proven unresponsive to other treatment methods.
What to Expect
Generally speaking, nerve blocks, regardless of the nerve being targeted for treatment, are performed under x-ray, fluoroscopic, or ultrasound guidance to ensure proper needle placement. The procedure will be with your physician administering a local anesthetic to the skin near the injection site, which will make the procedure less painful. After using imaging guidance to guide the needle into the proper place, your physician will deliver a dose of anesthetic to numb the nerve and prevent it from relaying pain signals. You will then be monitored for a period of time and discharge within an hour or so. Pain relief, if the procedure was effective, will be immediate and last for 24 to 36 hours.