Continuous Peripheral Nerve Block Using a Disposable Pump

What Is a Nerve Block?

A nerve block uses a local anesthetic in the area of a peripheral nerve to numb a specific area of the body for pain control. A nerve block can be used for surgery on the following: shoulder, elbow, forearm, wrist, hand, fingers, knee, leg, ankle, and foot.

Why Is a Nerve Block Used?

Doctors use nerve blocks to help patients feel better faster, recover more quickly, and go home sooner. Nerve blocks help to:

  • Significantly reduce pain after surgery

  • Decrease the need for pain pills

  • Lessen side effects of oral pain medication such as nausea, vomiting, constipation, itching, and sleepiness

  • Provide better rest after surgery

  • Allow easier participation in physical therapy, if needed

How Does a Nerve Block Relieve My Pain?

The peripheral nerve block catheter and infusion pump are used to help reduce pain following your surgical procedure.  All pain from the surgical procedure may not be relieved with this infusion.  You most likely will have additional medication to take by mouth, such as acetaminophen, an antiinflammatory medication, or gabapentin, to provide added pain relief. Your surgeon will also give you a prescription for pain pills to take if needed. Be sure to fill all prescriptions before going home. Carefully follow the directions for these oral pain medications.

Risks (These types of side effects are rare.)

  • Bleeding

  • Heart arrhythmias

  • Injury due to weakness/numbness

  • Nerve damage

  • Seizures

  • Confusion

  • Infection

  • Drug reaction

  • Drowsiness

  • Ringing in the ears

  • Dizziness/lightheadedness

  • Low blood pressure

  • Feeling like you can't take a deep breath

What to Expect Before Surgery

  • After checking in for your surgery, an anesthesiologist will see you to discuss your nerve block.

  • You will then receive medicine in your IV to help you relax.

  • The procedure starts with the anesthesiologist cleaning and numbing the skin where the nerve block is to be done. The anesthesiologist then inserts a stimulating needle and uses a small hand-held machine called a nerve stimulator. This machine sends a low-level electrical pulse below your skin to help pinpoint the exact location of the nerve. The signal causes a painless muscle twitch and possibly a tingling sensation.

  • The anesthesiologist may also use a small ultrasound machine.

  • The anesthesiologist then gently threads a small catheter, about the size of angel hair spaghetti or a heavy piece of fishing line, through the needle. The catheter stays in place and the needle is removed. A dressing covers the catheter.

  • A local anesthetic is injected through the catheter to numb the limb before surgery.

What to Expect After Surgery

  • The local anesthetic medication in the nerve block infusion will produce some numbness in the area of the body supplied by those nerves.

  • Because of the numbness, you could injure your arm, hand, leg, or foot without realizing it. You may have to wear a sling, brace, use crutches or other assistive devices while the nerve block is in place. Carefully protect these areas from any injury including heat, pressure, chemicals, or other objects while using the local anesthetic nerve block infusion.

  • The medication in the pump will also cause some muscle weakness in the arm, hand, leg, or foot.

  • During the nerve block infusion, do not try to use the limb with the blocked nerves as you normally would. You should not try to bear weight on a blocked leg or use a blocked arm to support yourself.

Care of the Catheter

  • If pain is not well controlled, check tubing for closed clamps or kinks. Also check to make sure there is fluid in the pump.

  • Keep the dressing over the infusion catheter clean and dry.  It is normal to have a small amount of clear or pink colored drainage under the dressing. Do not change the dressing; you can reinforce the dressing if needed.

  • No showers or tub baths while the catheter is in place; you may sponge bath.

  • Follow activity restrictions given to you by your surgeon.

Care of the Infusion Pump

  • The medication will be infused through an infusion pump about the size of a baby bottle. This will be set up for you after your surgery. Keep hub taped to skin. The pump should be kept within 18 inches of the catheter insertion site. You will not need to make any adjustments to the settings on the pump and should not try to do so.

  • When the pump is connected, the balloon inside the pump is full of medication and the plunger is all the way to the top. As the medication infuses, the balloon inside the pump will shrink and the plunger will go down. You may not be able to see the balloon shrinking for a day or more. The pump is empty when the balloon is completely deflated and the plunger is about halfway down and resting on its shelf.

  • You will receive a fanny pack that the pump and medication will be placed in for ease of carrying. Take caution not to drop the pump and to keep it out of water.

  • If your doctor decides that the medication infusion will be for an extended period of time, you will need to return to the clinic for a refill of the medication.

Removal of the Catheter

  • You will be removing the dressing and the nerve block catheter at home. Plan on removal on or about ______________________.

  • To discontinue the infusion, first gently lift the adhesive dressing over the catheter insertion site. Any remaining tape on the skin can be removed. The only discomfort you should feel is the pulling of the hair from the adhesive dressing.

  • Grasp the nerve block catheter as close to where it enters the skin as you can and gently pull it out. There should be no significant discomfort on removing the catheter, and little or no resistance to the catheter removal. There will be a blue tip or a metal tip at the end of the catheter. If you have any problem removing the catheter call the number provided. A small amount of blood or fluid drainage from the insertion site is normal.

  • Hold pressure over the site where the catheter was removed for 5 minutes. Then apply a Band-Aid® to the area. The Band-Aid® may be removed later that day. You may wash the area of the skin to remove any surgical soap or adhesive from the skin near the catheter insertion site as needed after the catheter is removed.

  • The numbness in the arm, hand, leg, or foot should be gone within 3 to 18 hours after removal of the nerve block catheter. Following catheter removal, you may have to continue taking oral pain medications as needed.

  • Discard nerve block catheter, tubing, and disposable pump. Do not attempt to remove the medication from the pump. The medication in the pump does not contain any opioid medication and is not intended for oral or intravenous injection. Toxic reactions could result from intravenous administration of this solution.

Symptoms to Report

  • Redness, tenderness, swelling, or pus-like drainage at the nerve block catheter insertion site

  • Bleeding from the nerve block insertion site

  • Lightheadedness, dizziness, or excessive drowsiness

  • Discoloration of the hand, fingers, foot, or toes

  • Ringing in your ears

  • Numbness and tingling around your face or mouth; metallic taste in your mouth

  • Significant change in pain or change in numbness in the arm, hand, leg, or foot

  • Drug reaction such as rash or itching

  • Pump leakage

  • Numbness or tingling lasting more than 24 hours after the catheter was removed

Follow-up Calls

  • You will receive a phone call at home during your infusion to evaluate your pain control and discuss any questions or concerns that you have related to the infusion. If you are having problems with the nerve block or infusion, don’t wait for someone to call you; call the number listed below in the box.

If you have questions or concerns call 1-800-782-8581, and ask for pager number 1850 for the anesthesiologist covering NERVE SHEATH CATHETERS.