Nerve block vs. sedation?

[49erinnc]

I have to have microscopic hand surgery next Tuesday to repair a severed nerve in my index finger. According to the scheduler, I will have the option of full sedation or having a nerve block administered. Assuming she's right, which would you prefer? And has anyone had any experience with nerve blocking surgery? Is this done via the spinal cord?

Kind of freaks me out to have that done but I suppose there are more dangers/risks involved with full sedation. I was sedated for my last surgery and I didn't handle it very well.

 

[kthroyer]

I had a femural nerve block, when I had my ACL replaced, but I was also sedated. The anaesthesiologist (sp?) told me that the nerve block would last for a few hours after the surgery, and that was the advantage to having it done. He did say that there was a small chance for nerve damage, but it was rare.

Also, if you have to have any IV's put in. See if the anaesthesiologist can do it for you. Their job is to make sure you are not in pain, and they will numb the area the needle goes into before they stick you. Mine was completely painless.

Good Luck

 

[Slew Foot]

<----- Anesthesiologist


What exact surgery are you having?

Im going to assume it's something short, a nerve block for the hand/upper extremity can be done in two ways. One is the Bier Block, where a tourniquet is inflated over the arm while an IV is placed. Local anesthestic(usually lidocaine) is injected into the arm via the IV which numbs the arm for a good hour or so. SOmetimes the tourniquet can cause some discomfort.

A true nerve block involves injecting local anesthetic into the neck(interscalene) or armpit(axillary) or maybe under the clavicle depending on what surgery you're having. A nerve stimulator is usually used to locate the nerve which can cause some discomfort while your arm twitches without you controlling it

At any rate youll probably have an IV started anyway in the opposite arm and can get sedation with the nerve block as well.

Let me know what exactly you're having done and I can give you more details.

 

[eits]

i say sedation... i've never trusted nerve block, really. it seems like there'd be too much of a risk of hitting the brachial plexus.

 

[Slew Foot]

Originally posted by: eits
i say sedation... i've never trusted nerve block, really. it seems like there'd be too much of a risk of hitting the brachial plexus.

Technically, you're supposed to hit the BP (well, at least come within 1mm of it) to properly perform the block. For something as small as what it appears he's having done, Id probably go with sedation as well. The nerve blocks are better for more painful procedures like shoulder decompressions or open rotator cuff repairs.

 

[kthroyer]

Hi Slew Foot,

Did you read my reply? Am I mistaken? I thought that I had a nerve block performed for my ACL replacement surgery, but I was pretty nervous, and maybe I misheard the anesthesiologist.

 

[Slew Foot]

Originally posted by: kthroyer
I had a femural nerve block, when I had my ACL replaced, but I was also sedated. The anaesthesiologist (sp?) told me that the nerve block would last for a few hours after the surgery, and that was the advantage to having it done. He did say that there was a small chance for nerve damage, but it was rare.

Also, if you have to have any IV's put in. See if the anaesthesiologist can do it for you. Their job is to make sure you are not in pain, and they will numb the area the needle goes into before they stick you. Mine was completely painless.

Good Luck

Yup that sounds exactly like a femoral nerve block. I usually give a little versed and fentanyl before performing a block to take the "edge" off the patient before placing the block. Depending on what they used, you can have relief between 6-24 hours.
During the surgery, most of my patients are placed under general anesthesia as well, since at the country medical center you have residents doing most of the surgeries and they can be unpredictable with the time they are going to take. You also dont want the patient to hear, "Oh ($#*(" during the middle of the case Sedation is also acceptable assuming the block is complete. Usually some combination of fentanyl, versed, and maybe propofol is given at the discretion of the anesthesiologist.

 

[kthroyer]

Originally posted by: Slew Foot

Originally posted by: kthroyer
I had a femural nerve block, when I had my ACL replaced, but I was also sedated. The anaesthesiologist (sp?) told me that the nerve block would last for a few hours after the surgery, and that was the advantage to having it done. He did say that there was a small chance for nerve damage, but it was rare.

Also, if you have to have any IV's put in. See if the anaesthesiologist can do it for you. Their job is to make sure you are not in pain, and they will numb the area the needle goes into before they stick you. Mine was completely painless.

Good Luck

Yup that sounds exactly like a femoral nerve block. I usually give a little versed and fentanyl before performing a block to take the "edge" off the patient before placing the block. Depending on what they used, you can have relief between 6-24 hours.
During the surgery, most of my patients are placed under general anesthesia as well, since at the country medical center you have residents doing most of the surgeries and they can be unpredictable with the time they are going to take. You also dont want the patient to hear, "Oh ($#*(" during the middle of the case Sedation is also acceptable assuming the block is complete. Usually some combination of fentanyl, versed, and maybe propofol is given at the discretion of the anesthesiologist.

Thanks for the reply. Everything that happened that day is a little fuzzy, 3 years later, but I remember the Anesthesiologist telling me about the nerve block.

 

[eits]

Originally posted by: Slew Foot

Originally posted by: eits
i say sedation... i've never trusted nerve block, really. it seems like there'd be too much of a risk of hitting the brachial plexus.

Technically, you're supposed to hit the BP (well, at least come within 1mm of it) to properly perform the block. For something as small as what it appears he's having done, Id probably go with sedation as well. The nerve blocks are better for more painful procedures like shoulder decompressions or open rotator cuff repairs.

why get so close? chance of periph. nerve damage... irony = that's what he'd get for what the surgeon's trying to fix

 

[Slew Foot]

Originally posted by: eits

Originally posted by: Slew Foot

Originally posted by: eits
i say sedation... i've never trusted nerve block, really. it seems like there'd be too much of a risk of hitting the brachial plexus.

Technically, you're supposed to hit the BP (well, at least come within 1mm of it) to properly perform the block. For something as small as what it appears he's having done, Id probably go with sedation as well. The nerve blocks are better for more painful procedures like shoulder decompressions or open rotator cuff repairs.

why get so close? chance of periph. nerve damage... irony = that's what he'd get for what the surgeon's trying to fix

Simply poking the nerve doesnt do any lasting harm. Unless you inject 30cc of lidocaine directly into the nerve, there wont be any lasting damage. And believe me, if youre injecting directly into a nerve, the patient will let you know.

 

[waggy]

when i had surgery on my shoulder i had a nerve block and sedation. the nerve block was good in the fact it kept pain away for hours after it. trouble is as it wore off it was weird. my arm tingled (felt like it was asleep).

 

[49erinnc]

Originally posted by: Slew Foot
<----- Anesthesiologist


What exact surgery are you having?

Im going to assume it's something short, a nerve block for the hand/upper extremity can be done in two ways. One is the Bier Block, where a tourniquet is inflated over the arm while an IV is placed. Local anesthestic(usually lidocaine) is injected into the arm via the IV which numbs the arm for a good hour or so. SOmetimes the tourniquet can cause some discomfort.

A true nerve block involves injecting local anesthetic into the neck(interscalene) or armpit(axillary) or maybe under the clavicle depending on what surgery you're having. A nerve stimulator is usually used to locate the nerve which can cause some discomfort while your arm twitches without you controlling it

At any rate youll probably have an IV started anyway in the opposite arm and can get sedation with the nerve block as well.

Let me know what exactly you're having done and I can give you more details.

Well, I'm not sure of the proper name for what's being done. But basically, they're cutting my right index finger open to resolve a Neuroma and then repair the nerve sheath, in hopes that the nerve will grow back at some point. I had a really nasty laceration with a broken wine glass on the inside/midway down area of my index finger. Aside from the pain from the neuroma, I have absolutely no feeling along the inside, most of the underside and a bit of the tip of the finger.

The surgeon told me it was about a 45 minute long surgery under the microscope so it doesn't seem to be a huge ordeal. I just didn't do very well with full sedation on a neck surgery I had back in August. Of course, I was under much longer and the surgery was far more significant. But I had a rough time coming out of sedation and it took me a full day to shake it off. Not to mention, I would think it would be cheaper to do the nerve block (correct me if I'm wrong). My deductible is $1500 and anesthesiology tends to absorb that before the surgeon/hospital.

I'd just like to avoid sedation after what I went through in August but it sounds like that may be what they want to do for this type of outpatient surgery.

 

[eits]

Originally posted by: Slew Foot

Originally posted by: eits

Originally posted by: Slew Foot

Originally posted by: eits
i say sedation... i've never trusted nerve block, really. it seems like there'd be too much of a risk of hitting the brachial plexus.

Technically, you're supposed to hit the BP (well, at least come within 1mm of it) to properly perform the block. For something as small as what it appears he's having done, Id probably go with sedation as well. The nerve blocks are better for more painful procedures like shoulder decompressions or open rotator cuff repairs.

why get so close? chance of periph. nerve damage... irony = that's what he'd get for what the surgeon's trying to fix

Simply poking the nerve doesnt do any lasting harm. Unless you inject 30cc of lidocaine directly into the nerve, there wont be any lasting damage. And believe me, if youre injecting directly into a nerve, the patient will let you know.

well, that's my worry... severing the nerve and injecting the lidocaine. but, apparently, it's not too much to worry about. that's good to know (especially for me)

 

[Tuktuk]

Sedation.. getting knocked out with drugs is fun