Peripheral Nerve Blocks BY Amanda Fleming RN MSN
Peripheral Nerve Blocks BY: Amanda Fleming, RN MSN Martica Canizares, RN BSN
What to Expect • Nerve blocks may affect control of movement, pain, and normal sensation. This causes feelings such as: » » » Weakness Numbness Tingling Heaviness A feeling that your arm or leg has fallen asleep
Duration • A nerve block can last anywhere from 2 to 24 hours, depending on the medications used and the effectiveness of the block • Medications that are used during the nerve block include: Versed and/or Fentanyl to sedate patient prior to nerve block and topical anesthesia (Lidocaine 1% and Neut) is used to numb the site • To block the nerve medication used are as follows: Naropin 0. 5%, Decadron 4 -8 mg, 100200 mcg of epinephrine
How to Assess • Usually the weakness wears off first, and then the patient will feel a numb/tingly sensation. • Finally, the pain may come back to the patient and could be mild to severe pain. This can occur in any order. • Remember pain is subjective. • Hourly rounding will immensely assist with assessing pain and wearing off the nerve block
Types of Block • A peripheral nerve block is a type of regional anesthesia (local to a particular part/body area) • The arm and leg are the most common areas for a peripheral nerve block. • Other areas include the head, neck, back, abdomen, and hip. • Sample of surgeries in which patients may receive a nerve block include: Orthopedic cases such as arthroscopy procedures: knee, shoulder, elbow and total replacement joints, and more
Importance of Pain Management • A patient may have received a block before, during, or after their surgical procedure. This does not mean a patient does not have pain after the surgery and does not need pain medication. • A nerve block can help reduce a patient’s pain after surgery and reduce the amount of pain medication needed. Be aware this may still require adjunctive/additional pain medications because this will wear off. • All patients should be assessed for pain and medicated appropriately as needed. • Nurses should make sure at time of report to receive information regarding if a block was done and if as needed pain medication has been ordered.
RN role in pain management • In report, receive information regarding: Type of surgery and location (which limb) Type of anesthesia used (note any reactions to it in OR? ) Last dose of pain meds given What pain meds have worked? Morphine enough? Any contraindications to PO meds? Movement restrictions to body part after surgery? Must document initial pain assessment upon pt’s arrival to floor and then as needed (and of course after each pain med given according to policy: 15 -30 mins after IV, 30 -60 mins after PO) – Be proactive! Do they have pain meds already ordered once they arrive to your floor that you can administer? Will they need antiemetics? – – – –
References Bouchard, C. (2009). Peripheral nerve blockade teaching brochure for ambulatory patients. . . State of the Science General and Oral Poster Sessions, AANA Annual Meeting, San Diego, California. AANA Journal, 77(5), 377 -377 1 p. Neal, J. (2002). Assessment of lower extremity nerve block: reprise of the Four P's acronym. Regional Anesthesia & Pain Medicine, 27(6), 618620 3 p.
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