Regional Anaesthetic (Peripheral Nerve block) in Children; Pre & Post operative advice

What is a Peripheral nerve block?

A Peripheral nerve block is an injection of local anaesthetic (numbing medicine) around a nerve. They are usually done when your child is anaesthetised (asleep).

They help to reduce the pain after surgery by making the surgical area feel numb. There are several types of blocks that target different nerves. For example, if your child is having an operation on their elbow, a nerve block can be performed in the armpit or neck to block the nerves that supply the arm.

Recent advances in ultrasound imaging mean that blocks can be done more safely and precisely. Your anaesthetist will tell you if there is a block that is appropriate for your child’s operation. They will discuss the benefits and risks and then you and your child can decide whether they would like a nerve block.

The nervous system

Benefits of nerve block / Regional Anaesthetic

• Better pain relief with fewer side effects, especially avoiding constipation, sickly or drowsy feeling associated with some of the other pain-relieving medicines.
• Potential for a faster recovery & ability to eat & drink.
• An alternative to strong pain relief medication in children who would receive help from avoiding them, for example those who have obstructive sleep apnoea or certain lung, liver or Kidney conditions.
• In operations where it is important to maintain a good blood supply to the operative site.

Risks of nerve block / Regional Anaesthetic

Common (Between 1 in 10 and 1 in 100 people)
Commonly, Local bruising or infection & Prolonged numbness lasting more than twice as long as expected.

Uncommon (Between 1 in 100 and 1 in 1000 people)
Uncommonly, Failure – if it happens, your child will receive alternate pain medication.

Rare (Between 1 in 1000 and 1 in 10,000 people)
Rarely, Damage to a blood vessel, Nerve damage. Please note that there is a risk of nerve damage after any operation even if a local anaesthetic block is not used. This can happen from use of tourniquet, positioning, surgery or swelling.

Very Rare (Between 1 in 10,000 to 1 in 100,000 people)
Very rarely, seizure, unconsciousness, or life-threatening event.

Frequently asked questions

How is the block done?

• Depending upon the surgery, a suitable block is performed with the help of an Ultrasound machine. Most of the time, your child will be asleep with the help of a general anaesthetic before the block.
  
  The Anaesthetist will use the Ultrasound machine to locate the nerves & then watch as they give numbing medicine (local anaesthetic drug) using a small needle.

What will happen after the block?

• All nerves in the affected area are also blocked so awareness of other sensations in the affected area will also be reduced. It is quite common & normal for your child to feel tingly or heavy in the numb area.

When should I start giving other pain-relieving medicine?

• It is important to give over the counter medicines such as Paracetamol and Ibuprofen before the numbing medicine wears off so that your child is not in pain when it does.

How do I look after the blocked area?

• While the block is working, there will be reduced ability to control movements, to feel hot or cold, or to feel pressure sensations in the blocked area. As a result, it is important to look after the blocked area. For example, by:
  – Supporting it with a sling.
  – Keeping it away from hot or cold things.

How long does the block last?

• The blocked area may be numb for anything from a few hours up to 18 hours or even longer depending upon the type of local anaesthetic used for the operation. The anaesthetist will discuss this with you on the day.

When should I seek medical advice?

• If the effects of the block last twice as long as what the anaesthetist told you.

Who do I contact if there are problems?

Step 1

Contact the ward that your child was discharged from on:

Step 2

Step 3