Regional Anesthesia & Pain Management (RAPM)

Patient Information

Nerve Blocks
Nerve blocks are when your anesthesiologist uses a needle to give you local anesthetic “freezing” medication near specific nerves to numb the pain. They may be performed with a single-dose of local anesthetic medication that lasts 8 to 24 hours, or your anesthesiologist might give you a “nerve plexus catheter.” This allows pain medicine to be given for a number of days. At Toronto Western Hospital these specialized techniques are used for some shoulder, hand, knee, and ankle/foot surgeries. However, the techniques are not suitable for all patients. You might discuss this option with your anesthesiologist.

At Toronto Western Hospital, there is even an operating room that is only used to do nerve blocks and epidurals for pain management. This is called the “block-room.”

Why should I have a nerve block?
If you have a nerve block you might not need a general anesthetic. If you do not have general anesthesia there is less chance that you will have nausea or sleepiness after your surgery. You might be able to go home sooner. Sometimes we give a nerve block as well as a general anesthetic. We do this to provide good pain relief following surgery after you have recovered from general anesthesia.

Will having a nerve block hurt?
Regional anesthesia involves placing a small needle near the nerves that supply the part of your body being operated on. This might cause a bit of discomfort, but we give all patients medicine when we do the nerve block and during surgery to help you relax.

Will I be awake during the operation?
Having surgery under regional anesthesia means that the part of your body that will be operated upon will be numb during the surgery (and often for a few hours after the surgery). Some patients prefer to be awake during surgery. Others prefer to be asleep. It is your choice. During your surgery you can be as awake or as asleep as you want. You never get to see the surgery itself because a large sterile drape is always placed between you and the surgeon.

How long will the nerve block last?
This depends on the type of block performed and type of local anesthetic (freezing) medicine used. For example, nerve blocks for hand surgery usually last for 3-4 hours, but a nerve block for pain after total knee replacement can be made to last for several days. The block lasts for longer if local anesthetic is delivered through a plastic tube placed next to the nerve when we do the block.

Is regional anesthesia safe?
Like general anesthesia regional anesthesia involves some minor risks. Rarely some patients (less than 1%) have “pins and needles” in an area previously blocked by the local anesthetic and this can last for 3-4 weeks following surgery. However, regional anesthesia provides much better pain control and decreased side effects, such as sleepiness and nausea, compared to general anesthesia.

Will I get any side effects from the nerve block?
Side effects nerve blocks are rare but, but they happen sometimes. It is very rare to have an allergy to local anesthetic. In a small number of patients some local anesthetic might be injected into the blood stream. This can cause an increase in heart rate and also some symptoms such as ringing in the ears and a metallic taste in the mouth. These symptoms by themselves are not harmful and they will soon go away. However, it is important to tell your anesthetist if you get these symptoms.

Will I get a bruise where I get the needle goes in?
A small bruise is common at the site of needle insertion. This may be slightly tender afterward. However the small amount of soreness is worth it for the pain control you will get from the block after your surgery.

How long will the block take?
Usually the block takes 5-10 minutes to do. It takes another 10-15 minutes to start working fully. We always make sure the block is working before you go into the operating room. You will be given some medicine to help you relax when we do the block.

Will I get the nerve block in the same room as where the surgery takes place?
No. We do the nerve blocks in another room near the operating room. This lets you have the block done in a quiet place before you are moved to the operating room for surgery.

Do I have the right to refuse the block?
Yes. We can only tell you about your options. We will advise you to have surgery with regional anesthesia (nerve block) if we think it provides the best anesthetic conditions with the least side effects.

In some rare situations general anesthesia may be much riskier compared to having surgery with a nerve block. In these cases we would strongly advise you to have a nerve block for surgery.

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