Peripheral Nerve Blocks and Lesioning and Surgical Pain Management

Abstract

Peripheral nerve blocks are used to treat a variety of chronic pain conditions in the outpatient setting. In the perioperative setting, they have been shown to decrease hospital length of stay, provide better pain control, and have fewer side effects when compared to epidural anesthesia or patient-controlled opioid therapy. The number of hospitals providing acute pain services is increasing, and peripheral nerve blocks are an important aspect of these services. Blocks can be used as the sole modality for analgesia for a procedure or be used as an adjunct to general anesthesia or moderate/deep sedation to allow for improved pain control in the acute setting. Some contraindications to peripheral nerve blocks include infection of the skin over the area of needle insertion, neuropathy of the nerves to be blocked, and the presence of a coagulopathy. Risks of the procedure include, but are not limited to, infection, nerve damage, bleeding, possible falls if the block is performed on a lower extremity, and pneumothorax for brachial plexus and chest wall/thoracic spine procedures.