Nerve Block...

[jnr450r]

Dr. Mark whats your take on nerve blocks over endotracheal anesthesia..??? I'm going in for a revision of the left unla(broken plate-healed wrong) and the new Doctor orderd a NB. I've never had one and was looking for some info..........

[DrMark]

Nerve blocks ae the latest fad in anesthesia to earn more per case. Last month some knucklehead anesthesia guy put the block into the artery of some guy and he was seizing and almost didn't make it. Hardly worth it for a 40 something KTM rider with a torn tendon in his shoulder.

I think you shouldl reconsider if you want the jerk to do your surgery.

[btc20mx]

The surgeon or whoever gave me a nerve block from the top of my thigh when I had my heel plated. Everything was good until it started to wear off then all hell broke loose and I thought I was going to die it hurt so badly. It literally was the worst part of the ordeal, way worse than the break. It was like your whole leg falling asleep multiplied by a thousand. I never want to have that again if I can help it.

[jnr450r]

Thank you Dr. Mark....I wasn't so incline to have someone mess with my nerves anyway. I'm going to request GA.

[motocross10113]

I have had 3 never blocks done in my right shoulder i love them there great for pain control when u wake up and i get to go home the same day and not feel like crap the key is to start taking you meds soon as u feel it going away...tiggaling....moving of anyshort....nerve blocks are much more safe than a general anesthesia

[moochie]

I have had 3 never blocks done in my right shoulder i love them there great for pain control when u wake up and i get to go home the same day and not feel like crap the key is to start taking you meds soon as u feel it going away...tiggaling....moving of anyshort....nerve blocks are much more safe than a general anesthesia

I agree! I always suffer from nausea the day following surgery regardless of the anti nausea medication I've been given. I had a nerve block for my ACL repair and in addition to feeling no pain for 24 hours, I didnt have any nausea to deal with. Worked great for me!

[coffee]

Joking with the anesthesiologist (sp?) and he said he could make my leg numb for 2 years if he wanted to. It was a month before it wore off....at least that is what I thought it was.

Or it could be my mental state at the time - trying not to break my leg again to find out.

.

[skidlid]

The surgeon or whoever gave me a nerve block from the top of my thigh when I had my heel plated. Everything was good until it started to wear off then all hell broke loose and I thought I was going to die it hurt so badly. It literally was the worst part of the ordeal, way worse than the break. It was like your whole leg falling asleep multiplied by a thousand. I never want to have that again if I can help it.

Same story here they put nerve block in the back of my knee at 7am had surgery at 8am buy 11am I was in the car on my way home. Within an hour I thought I was going to die from the pain. We had to order ahead a prescription for demerol. That whole first day I never slept and was in more pain than when I originally broke my leg.

I have had other surgeries and always had spinal taps, I never felt sick or suffered from this amount of pain. I was told they like nerve blocks so the patient does not have to stay soo long for the spinal tap to wear off? I will request not to have a nerve block in the future.

[moochie]

Same story here they put nerve block in the back of my knee at 7am had surgery at 8am buy 11am I was in the car on my way home. Within an hour I thought I was going to die from the pain. We had to order ahead a prescription for demerol. That whole first day I never slept and was in more pain than when I originally broke my leg.

I have had other surgeries and always had spinal taps, I never felt sick or suffered from this amount of pain. I was told they like nerve blocks so the patient does not have to stay soo long for the spinal tap to wear off? I will request not to have a nerve block in the future.

Maybe I'm missing something here?

If you guys would have had general anesthesia for your surgeries, how do you think that would have lowered the amount of pain you were experiencing after the surgery?

General anesthesia to put you under for the surgery will not do anything for the pain your feeling afterwards.

As someone stated above, once the nerve block begins wearing off your going to need to be on some kind of pain med if you're uncomfortable.

My nerve block lasted for about 24 hours and by the time it wore off I was starting up with the pain meds, however, at that point it felt like the worst was already over with.

[motocross10113]

Maybe I'm missing something here?

If you guys would have had general anesthesia for your surgeries, how do you think that would have lowered the amount of pain you were experiencing after the surgery?

General anesthesia to put you under for the surgery will not do anything for the pain your feeling afterwards.

As someone stated above, once the nerve block begins wearing off your going to need to be on some kind of pain med if you're uncomfortable.

My nerve block lasted for about 24 hours and by the time it wore off I was starting up with the pain meds, however, at that point it felt like the worst was already over with.

I agree all three of mine lasted about 8-12 hours and i started meds soon as i felt it going away there are much less risks with then than a general anesthesia i know ppl that have had them done in there shoulders, arms,hands seems like ppl might be have trouble with the legs??? mabye a not so hot doc...who knows but i have herd nothing bad.

And since general does nothing for pain you wake up and are usally on something like morphin or Dreminal...and Dreminal makes me very sick...i would rather be able to go home than sit there puking all day cuz they cant get my pain under control...i have done both i have had a rack of surgerys

[coffee]

Just went over some old notes - it started wearing off slightly at 2 weeks, could feel a fair amount at 4 weeks, and completely went away after 5 weeks.

Dr. Mark - how is that possible? Felt just like novacain...

.

[DrMark]

Coffee you did better that the 40 year old KTM rider from Michigan who I think they injected into the carotid artery and he was had to stay intubated for 6 days before he woke up. It was pretty terrible for his wife, his parents, and me. He was out of it, and didn't know what was going on. Thank God, he turned out ok.

I was at a national meeting las month and spoke with Dr. Hawkins (Steadman-Hawkins Clinic) He told me about the same story that he had had with one of his patients.

These blocks are not for fun, and when I had surgery to remove a pilonidal cyst from the base of my spine this past Tuesday, I refusd the block. I would rather have some pain, that have to even run the risk of a terrible complicaton. Just me talking...

For you a little numbness wasn't a big problem. If you need the other side done, I will give you a few extra Vicodan.

[coffee]

I can assure you I am doing everything in my power not to break anything else.

I can also more strongly assure you that if I do break something and it is at all possible you will meet me.

,

[DrMark]

Thanks Coffee.

And I can assure you that I won't let them give you a nerve block.

[sctilt]

After a recent shoulder procedure I was given one of these. It lasts for 3-5 days and then you pull out the catheter yourself. Worked pretty well.

http://www.erdamed.com/E.Pain%20Buster.htm

[DrMark]

The pain buster is a good idea. In Texas, they charge $2500 for it. Most of the insurers won't pay for it, and few of my patients can afford that kind of money.

[moochie]

I'm no doctor, but based on the good results I had with 2 nerve block procedures, I'd agree with the results I see when I google the topic "nerve block vs. general anesthesia. The top results in the search returned comments much like this....

"block with a short-acting local anesthetic was associated with time-efficient anesthesia, faster recovery, fewer adverse events, better analgesia, and greater patient acceptance than GA"

The procedure is apparently involved in more controversy than I had thought.

[See-Are-Ef-Too-Thir-T-Ef]

My Dad uses them everyday. I talked to him about it and he says he rarely ever has a problem. He says for the most part, when it wears off the pain goes up, some people start panicing for about an hour, then it's off. Or, you take the vicodin right when it wears off. When he got his abdominal hernias out, he was on vic for a nite, and then personally prefered not to use any pain killers after that and got up moving around the next day, he said its better to get the pain done early, instead of dragging it out over a week. Lol, kinda sounds funny coming from a physician.

[jbrownmxr]

The pain buster is a good idea. In Texas, they charge $2500 for it. Most of the insurers won't pay for it, and few of my patients can afford that kind of money.

Gotta jump in here. I'm an Anesthesiologist working in So. Cal. My primary practice is anesthesia for orthopedics and we (my partners and I) do blocks daily. The SURGEONS and PATIENTS request them. Let me give you an outline. Oh, and this is for nerve blocks. Not spinals or epidurals which I can also talk about.

1. Nerve blocks are usually used in conjunction with a general anesthetic to decrease postoperative pain, and decrease the need for narcotics and anesthetics which have side effects.

2. Nerve blocks in the best of hands have an efficacy of about 80%. Dr. Mark will tell you this is good.

3. Nerve blocks have side effects and risks. Just like Dr. Marks proceedures, whenever your skin is violated by an object, in this case a needle, there is the possibility of bleeding, infection, nerve damage,...blah...blah...They are not overly risky so long as the practitioner is capable. I often hear surgeons refuse to do something because this one time there was this guy who had this bad outcome. Sheez. Ever had a wound infection? Ever had a grafted ACL come loose? Ever had a patient develope RSD? If so you should stop doing all these proceedures imediately. The fact is all proceedures have the risk of doing harm. This is medicine.

4. Nerve blocks are not new. The use of local anesthestics to deaden a nerve have been around since the 1800's.

5. Nerve block reimbursement to the practioner is variable. Hence decideingto do one based on this alone is folly. I may not get paid at all. It is stricktly offered as a service.

6. Pain busters DO NOT work as well as a well placed block. Period. And I think in this case the surgeon bills for the placement of the device.

My take. The purpose of the nerve block is to decrease post operative pain, decreaseing your need for pain medications and anesthesia. For the very vast majority they work great. If I were to have an ACL repair I would want a block. I would only want to know if the Anesthesiologist putting it in made these proceedures a regular part of his practice. If so, I'd do it.

[DrMark]

My bad experience may be based on a guy our anesthesia group just fired, so its probably not enough to base serious objections on. Hopefully, will will get some guys who can do it well.

There also is no question that that the nerve block works better than the pain pump.

BTW doc, since I quit doing allografts, I haven't had an ACL that come loose, although I have not been free of complications.